Monet Dawkins
Summary
Conscientious professional with extensive experience advocating for social and economic well-being of individuals and families. Skilled at providing guidance, support and assistance. Strong communication and management skills and committed to inspiring community service.
Overview
22
22
years of professional experience
Work History
Client Service Supervisor
Immuno Laboratories
04.2016 - 06.2023
- Demonstrated full understanding of the Food Sensitivity Tests offered by Immuno Laboratories, and communicated available options to the patients and providers.
- Assist Physicians with processing routine orders for patient lab tests.
- Manage CRM order details, verify and track specimen shipments and results.
- Schedule and facilitate on-site interviews with management for potential new hires.
- Partner with Human Resources and C-Suite Executives for all Call Center related HR requirements including new hires, terminations, LOA, Worker's Comp Claims, and Grievances.
- Conducted training and mentored team members to promote productivity and commitment to friendly service.
- Created customer support strategies to increase patients retention.
- Participated in community events to promote services and engage with public.
Patient Service Representative
Hospital Physician Partners
09.2015 - 03.2016
- Entered patient demographic and insurance data into electronic medical record system.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Managed patient registration process, confirming data accuracy and completeness.
- Built and maintained positive working relationships with patients and staff.
- Took copayments and compiled daily financial records.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Handled customer service inquiries in person, via telephone and through email.
- Developed and implemented customer service policies and procedures.
- Investigated insurance claims denials and appeals.
- Verified patient insurance eligibility and entered patient information into system.
- Investigate, research, process, resolve and respond to member and provider inquiries and quality of care issues via telephone
- Initiate claim adjustments on individual cases when necessary and follow and track until completion
- Educate members and providers on procedure codes and the process for adjudicating routine claims.
- Communicating with patients and their families about the details of their bills and insurance restrictions.
- Process payments from the insurance and make the contractual agreement adjustments on the accounts
- Active member of the Employees Committee Board responsible for coordinating activities to increase employee morale.
Clerical Representative
Hospital Physician Partners
10.2013 - 09.2015
- Review LOAs from Law offices to release patient's medical statements and medical records to attorneys for payment of services rendered for auto and workers compensation claim
- Coordinate work flow and schedules for routine legal documents including: write-offs, collections, bankruptcies, and death certificates
- Review and audit LOAs to verify patient consent prior to releasing documents to designated attorneys.
Insurance Advocate
Hospital Physician Partners
05.2013 - 09.2013
- Analyze claims to determine validate liability, approval or denials and negotiate with claimants in accordance with policy provisions
- Collaborate with insurance agents and interview claimants to correct errors, rectify omissions and investigate questionable issues
- Review and process appeal claims for payments
- Updating physician's credentials such as, NPI, W9's, Provider numbers, Medicaid ID's and physician's license to practice
- Processing write offs within required timeframes.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Prepared summaries of damage, payments, and policy coverage.
- Answered customer questions regarding deductibles.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Documented all investigation activity and presented reports to management.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
Customer Service Supervisor
EDiets.com
10.2010 - 05.2013
- Interviewed, hired, trained and managed new sales and customer service/retention employees to meet seasonal staffing needs
- Introduced training programs that enhanced employee performance and helped build a motivated workforce
- Monitor call, email and chat data to ensure departmental productivity goals are achieved
- Modified evaluation/quality control procedures to measure the performance of each agent, and completed these evaluations on a daily, weekly, and monthly basis
- Communicated with potential and existing customers via phone, chat and email platforms to help optimize revenue earnings
- Express unmatched commitment to customers, provide unsurpassed service by understanding, anticipating, and exceeding their expectations
- Carry out systematic and rational analysis to identify the root cause of issues, make informed judgment, anticipate and prevent recurring problems
- Utilizes touchpoints & cross selling techniques to promote positive member relations and enhance the value of Platinum membership.
- Conducted training and mentored team members to promote productivity and commitment to friendly service.
- Coached team members to deliver hospitable, professional service while adhering to set service models.
- Actively supported service associates by quickly responding to questions via phone and email and finding appropriate solutions to customer issues.
- Set priorities and problem-solved workflow issues to maintain rapport with customers and managers.
Customer Service Representative
Aetna, CVS Health
09.2008 - 05.2010
- Handle incoming calls from members and providers regarding claims status, benefits and eligibility, and PPO participation
- Maintain department established performance metrics
- Speak with members and providers regarding healthcare policies, procedures, certificates, riders and benefits as related to inquiry processing
- Educate members and providers on procedure codes and the process for adjudicating routine claims.
Quality Assurance Specialist
Teleservices Direct
01.2001 - 12.2007
- Assisted with the creation and implementation of quality assurance requirements and standards for within the Call Center
- Analyzed and reviewed agent performance metrics to identify weaknesses and trained to mitigate defects and convert into strengths
- Monitored associates to ensure departmental procedures and standards were upheld
- Coached representatives and provide constructive feedback to ensure ongoing development
- Assisted management in creating development plans for agents to help deliver excellent customer service.
Education
Associate of Science - Nursing
Jersey College of Nursing
Sunrise, FL08.2023
CAREER CENTER FOR TRAINING
07.2010
MCFATTER TECHNICAL CENTER
05.2010
High School Diploma -
JONATHAN GRANT HIGH SCHOOL
Jamaica, West Indies07.2000
Skills
- Healthcare Support
- Microsoft Office Suite
- New Hire Onboarding
- Customer Service & Support
- Claims and Appeals
- Quality Assurance
- Client Needs Assessments
- Community Outreach
- Schedule Management
- Training and Mentoring
- Written and Verbal Communication
- Service Planning
Timeline
Client Service Supervisor
Immuno Laboratories
04.2016 - 06.2023
Patient Service Representative
Hospital Physician Partners
09.2015 - 03.2016
Clerical Representative
Hospital Physician Partners
10.2013 - 09.2015
Insurance Advocate
Hospital Physician Partners
05.2013 - 09.2013
Customer Service Supervisor
EDiets.com
10.2010 - 05.2013
Customer Service Representative
Aetna, CVS Health
09.2008 - 05.2010
Quality Assurance Specialist
Teleservices Direct
01.2001 - 12.2007
Associate of Science - Nursing
Jersey College of Nursing
CAREER CENTER FOR TRAINING
MCFATTER TECHNICAL CENTER
High School Diploma -
JONATHAN GRANT HIGH SCHOOL
Software Platforms
- Healthcare: Healthxnet, Althenanet, Emedeon
- Call Center: Sales Force, Live Chat
- Microsoft Office: Word, Outlook, Power Point
- Human Resources: ADP, PeopleSoft
Software Platforms
- Healthcare: Healthxnet, Althenanet, Emedeon
- Call Center: Sales Force, Live Chat
- Microsoft Office: Word, Outlook, Power Point
- Human Resources: ADP, PeopleSoft
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