Nalei-Maile Ferro
Las Vegas
Summary
Accomplished Authorization Rep II at Bio Plus, adept in problem-solving, significantly enhanced service levels to high 90's. With expertise in financial analysis and software, successfully mentored new hires at Health Management Systems, showcasing high QA scores and a knack for fostering customer satisfaction through efficient claims processing and authorization management.
Experienced with managing high-volume inbound calls and resolving customer inquiries efficiently. Utilizes strong communication and problem-solving skills to improve customer satisfaction. Knowledge of customer service protocols and adept at adapting to dynamic environments.
Overview
20
20
years of professional experience
Work History
Patient Access Center Representative I
NYU Langone Health
09.2024 - Current
- Provided exceptional support to patients, ensuring all needs were met within a timely manner.
- Assisted customers with scheduling appointments, resulting in increased patient satisfaction.
- Boosted first-call resolution rates by thoroughly assessing caller needs and providing accurate information promptly.
- Handled high volume of inbound calls, maintaining patience and professionalism under pressure.
- Effectively managed multiple priorities simultaneously within a fast-paced environment, ensuring optimal time management skills remained at the forefront.
- Provided excellent customer service to patients and medical staff.
Authorization Rep II
Bio Plus
02.2024 - 08.2024
- Developed and maintained effective relationships with external customers to ensure satisfaction with services provided.
- Maintained up-to-date knowledge of insurance plans, regulations, laws, and provider contracts.
- Performed data entry into the system for all incoming authorizations.
Provider Relations Rep I
Health Management Systems (HMS)
10.2019 - 02.2024
- Handles 45+ inbound and outbound calls from Providers for recoupment status as well as appeal status
- Works with variety of systems to confirm information for providers
- Works special projects as assigned
- Assists in new team structure to accommodate better service levels
- Results Accelerator Project team member (trained in 30 days for the following departments: Dependent Verification, Premium Assistance, Subrogation and ACD- taking calls bringing service levels up from 30% to high 90's)
- RA Trainer for Payment Integrity Las Vegas.
Customer Service Representative II-Provider Services
Centene
11.2017 - 05.2019
- Handled inbound calls from providers for benefits and eligibility, claims and prior authorizations
- Peer Coach, assisting with escalation calls, monitoring group chat, answer questions from other reps
- Assisted in training of new hires and mentoring for calls on B & E and claims
- High QA Scores
- Averaged 31+ inbound calls per day
Case Manager
McKesson Specialty Health
04.2017 - 09.2017
- Handled inbound and outbound calls from patients caregivers and other healthcare professionals
- Completed benefits investigations and conducted follow up reviews on prior authorizations
- Contacted various healthcare providers and patients to inform them on medication claims
- Experience working with various health insurances and co pay assistance programs.
Provider Resolutions Team Leader
United Healthcare Group
07.2015 - 04.2017
- Handled 65+ inbound calls from providers to requests statuses on claims and benefit eligibility
- Responded to daily correspondence from team members and other customers
- Handled escalated calls from members
- Monitored team member chats systems and conducted team huddles to go over goals and expectations
- Responsible for coaching for new hires, providing feedback and monitoring QA's for calls
- Held special training sessions for changes systems, procedures and policies.
Customer Service Associate
Stella & Dot
09.2014 - 05.2015
- Handled calls from customers regarding product orders and refunds
- Responded to email correspondence from customers with inquiries about services
- Assisted customers with setting up individual websites to help with promotional services marketing.
Member Services Representative
Vemma Nutrition Company
04.2014 - 09.2014
- Developed and maintained effective relationships with external customers to ensure satisfaction with services provided.
- Maintained up-to-date knowledge of insurance plans, regulations, laws, and provider contracts.
- Performed data entry into the system for all incoming authorizations.
- Handled 40+ inbound calls per day from members placing orders
- Tracked shipments and conducted website trouble shooting
- Collected payments for products during transactions.
Student Contact Representative
Carrington College
08.2012 - 02.2014
- Handled over 220 inbound and outbound calls per day
- Communicated with potential and current students with degree inquiries
- Trained new staff on inbound call procedures.
Dispatcher/ Billing Representative
First Service Networks
09.2010 - 06.2012
- Set up and scheduled appointments for repair technicians
- Utilized a variety of systems for mapping routes
- Invoiced and billed for projects and orders that were complete
- Ran daily reports to track progress for service orders.
Dispatching Representative
Dish Network
06.2005 - 09.2010
- Handled outbound calls to route technicians throughout Arizona, Las Vegas and S
- California
- Responsible for day to day and monthly reports to track service claims.
Education
Associate of Arts - Hotel Operations/Culinary Arts
Kapiolani Community College
Honolulu05-1997
Skills
- Loss Prevention
- Problem-solving aptitude
- Financial Analysis
- [Software] expertise
- Call handling
- Customer service
- Problem-solving
- Friendly and outgoing
- Multitasking and organization
- Verbal and written communication
- Phone and email etiquette
Timeline
Patient Access Center Representative I
NYU Langone Health
09.2024 - Current
Authorization Rep II
Bio Plus
02.2024 - 08.2024
Provider Relations Rep I
Health Management Systems (HMS)
10.2019 - 02.2024
Customer Service Representative II-Provider Services
Centene
11.2017 - 05.2019
Case Manager
McKesson Specialty Health
04.2017 - 09.2017
Provider Resolutions Team Leader
United Healthcare Group
07.2015 - 04.2017
Customer Service Associate
Stella & Dot
09.2014 - 05.2015
Member Services Representative
Vemma Nutrition Company
04.2014 - 09.2014
Student Contact Representative
Carrington College
08.2012 - 02.2014
Dispatcher/ Billing Representative
First Service Networks
09.2010 - 06.2012
Dispatching Representative
Dish Network
06.2005 - 09.2010
Associate of Arts - Hotel Operations/Culinary Arts
Kapiolani Community College
Awards
Employee of the Month March 2016-United Healthcare
Similar Profiles
Estefania GallegoEstefania Gallego
Research Laboratory Supervisor at NYU Center for Biospecimen Research and Development, NYU Langone HealthResearch Laboratory Supervisor at NYU Center for Biospecimen Research and Development, NYU Langone Health
Claire Cooper, MSPHClaire Cooper, MSPH
Senior Project Coordinator at NYU Langone Health - Department of Population HealthSenior Project Coordinator at NYU Langone Health - Department of Population Health
Kowssar SafaKowssar Safa
Intern at Family Health Center – NYU Langone HealthIntern at Family Health Center – NYU Langone Health
Benita MohabirBenita Mohabir
Medical Assistant at NYU Langone Health-Center For Women's HealthMedical Assistant at NYU Langone Health-Center For Women's Health
Ariana CoomerAriana Coomer
Barista at Jamba JuiceBarista at Jamba Juice