Monique Smith
Virginia Beach,VA
Summary
Customer Service Specialist with extensive experience in resolving issues promptly and professionally, maintaining accurate records, and utilizing CRM software for trend analysis. Skilled in insurance verification, claims processing, and effective problem-solving. Bringing strong communication and analytical skills to foster positive client relationships and improve service delivery.
Professional with proven expertise in patient account management and revenue cycle operations. Adept at resolving billing issues, ensuring accurate financial records, and maintaining compliance with healthcare regulations. Strong focus on team collaboration and achieving results, with flexible approach to adapting to changing needs. Known for excellent communication, problem-solving skills, and commitment to patient satisfaction.
Overview
10
10
years of professional experience
Work History
Customer Service Specialist
CVS/caremark
07.2023 - 11.2024
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
- Enhanced customer satisfaction by resolving issues promptly and professionally.
- Adapted quickly to changes in company policies or procedures ensuring consistency in delivering accurate information to customers.
- Tracked customer interactions using CRM software, helping the team identify trends and areas of improvement in service delivery.
- Using salesforce to access customer account to make necessary changes , look up information , or updating demographics.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Assisted customers in navigating insurance claims, resulting in fewer denials and improved coverage understanding.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Managed approximately 30-80 incoming calls, email, and faxes per day from customers.'
- Answered 15-25 inbound calls from existing and future policyholders to answer inquiries and discuss insurance options.
- Performed needs analysis to obtain information required to make appropriate health insurance product recommendations.
Patient Account Representative
Optima Health Insurance
12.2021 - 04.2023
- Prepared reports detailing billing actions, flags and other key information.
- Utilized computer programs to create invoices, letters and other documents.
- Reconciled statements with patient records.
- Demonstrated adaptability in navigating complex payer guidelines to maximize reimbursement opportunities for the organization.
- Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
- Electronically submitted bills according to compliance guidelines.
- Enhanced patient satisfaction by promptly addressing inquiries and resolving account issues.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Posted payments and processed refunds.
- Negotiated payment plans with patients experiencing financial difficulties, supporting them in meeting their obligations without undue stress.
- Developed comprehensive understanding of medical terminology, coding systems, and billing procedures for accurate claim processing.
- Collaborated with interdisciplinary teams to develop best practices for resolving high-priority claims quickly and accurately.
- Expedited service times with effective triage of incoming calls, directing patients to the correct department or resource within a 5 min hold time
Client Service Representative
Capital Group
06.2019 - 11.2021
- Maintained accurate record-keeping with proactive attention to client information updates.
- Coordinated with operations staff to resolve service problems and boost client satisfaction.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Consistently met or exceeded performance metrics while juggling multiple tasks effectively under tight deadlines.
- Developed strong relationships with clients through proactive outreach and regular check-ins on progress and satisfaction.
- Maintained detailed records of client interactions, allowing for better understanding of needs and preferences for future engagements.
- Educated customers about billing, payment processing and support policies and procedures.
- Took approximately 10-15 escalated calls to maintain customer satisfaction and to improve professional driven results
Collections Account Manager
Portfolio Recovery Associates
03.2015 - 04.2019
- Maintained strong client relationships through effective communication and empathetic negotiation skills, fostering a positive experience during difficult financial situations.
- Increased recovery rates by conducting thorough investigations into debtor circumstances and tailoring collection approaches accordingly.
- Reviewed 5 collection reports regularly with management to provide updates on progress and potential areas for improvement.
- Managed account portfolio effectively, ensuring accurate record-keeping and timely follow-ups on outstanding balances.
- Consistently met or exceeded monthly targets for successful collections, contributing to the overall financial health of the organization.
- Assisted with day-to-day operations, working efficiently and productively with all 13 team members.
Education
No Degree - Business Administration And Management
Strayer University
Virginia Beach, VAHigh School Diploma -
IC Norcom
Portsmouth, VA06-2013
Skills
- Customer Service
- Good communication skills
- Customer Relations
- Call center experience
- HIPAA Compliance
- Insurance Verification
- Insurance Billing
- Effective problem solving
- Claims Processing
- Strong analytical skills
- Payment Processing
- Verbal and written communication
- Time Management
- Team Leadership
Timeline
Customer Service Specialist
CVS/caremark
07.2023 - 11.2024
Patient Account Representative
Optima Health Insurance
12.2021 - 04.2023
Client Service Representative
Capital Group
06.2019 - 11.2021
Collections Account Manager
Portfolio Recovery Associates
03.2015 - 04.2019
No Degree - Business Administration And Management
Strayer University
High School Diploma -
IC Norcom
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