Summary
Overview
Work History
Education
Skills
Educationandprofessionaldevelopment
Timeline
Generic

Nikka Walton

DeSoto,TX

Summary

Results-oriented professional with extensive experience in customer service and administrative functions within the health care sector. Proven expertise in conflict resolution and data entry has consistently enhanced client satisfaction and streamlined operations. Demonstrated leadership in navigating high-stakes situations has led to significant improvements in customer retention and operational efficiency. Aiming to leverage these skills to contribute to growth in a forward-thinking organization.

Overview

17
17
years of professional experience

Work History

Customer Service Representative

Aetna at CVS Health
Jacksonville, Remote
11.2024 - Current
  • High volume Medicare claim calls at Provider contact center for Aetna assisting with claims status, reworks and benefits and eligibility
  • Utilize multiple applications and available resources to ensure prompt provider satisfaction
  • Streamlined claim verification using tools like Claims Xten, TPS McKesson, Cotiviti and HRP.
  • Followed and upheld policy, procedures, and confidentiality standards.
  • Resolved provider inquiries efficiently through customized phone support.
  • Handled high-priority fax escalations related to claims and time-sensitive issues.
  • Ensure clarity on subsequent steps for claim resolution processes.
  • Investigated current advise statuses related to preauthorizations.
  • Communicated benefit information effectively.
  • Evaluate compatibility of CPT codes with provided diagnosis codes for accuracy.
  • Communicated limits, restrictions, and billable times according to pay policies.

Provider Experience Lead

ChampVA
Omaha, Remote
11.2022 - 03.2024
  • Coordinated with families of veterans to resolve medical insurance claims and eligibility issues.
  • Handled complaints and escalations related to congressional threats for providers, veterans, and beneficiaries.
  • Maintained confidentiality in adherence to HIPAA regulations.
  • Facilitates the update of secondary health insurance information and benefit coordination.
  • Managed emergency transmissions for timely processing of claims.
  • Guided customer service team in resolving questions related to claims and denials.
  • Reopened and reprocessed incorrectly denied claims.
  • Corrected filing errors by relocating appeals to designated correspondence sections.
  • Oversaw the accuracy of information provided by customer service staff.

Patient Care Technician

Premise Health at Lockheed Martin
Grand Prairie, TX
01.2022 - 10.2022
  • Conducted patient interviews and measured vital signs including pulse rate, temperature, blood pressure, weight and height.
  • Organized treatment spaces to ensure readiness for exams.
  • Ensured adherence to policy, procedures, and HIPAA regulations.
  • Performs routine CLIA waived laboratory tests/collects specimens for routine laboratory tests
  • Welcomed and assisted all visitors and callers to the health center.
  • Managed inventory and procurement of healthcare supplies.
  • Coordinates scheduling of patient appointments and performs follow-up communication.
  • Performs administrative tasks, completes appropriate client company and OSHA regulated forms, and assists at the front desk
  • Answer and make high volume incoming and outgoing calls
  • Receive appointment requests
  • Identify and or create new MRN for patients
  • Verify correct insurance and demographic information

Administrative Assistant

Premise Health at Goldman Sachs
Dallas, TX
01.2018 - 01.2022
  • Provide ongoing administrative support to senior executives, driving organizational success through the management of daily operations and special projects
  • Manage executive calendars, strategically coordinating meetings, appointments, events, travel arrangements, and reserve conference areas
  • Compose and proofread memos, letters, reports, and presentations, providing accurate, concise, and error-free communication
  • Schedule patient appointments and request agency coverage for out of office staff
  • POCT Swabbing of patients for COVID- SARS
  • Request delivery for covid vaccines

Customer Relationship Manager II

J.P. Morgan Chase
Arlington, TX
08.2015 - 01.2018
  • Processed vehicle title release in conjunction with current state laws and regulations, with legal signing authority for organization
  • Analyzed, review and process of payments, payment plans and payoffs
  • Was responsible for conceptualizing and managing a diverse range of customer retention campaigns and initiatives leading to consistent customer satisfactions
  • Responded to customer inquiries and concerns in a timely manner and created customized solutions
  • Handled all emails, external/internal mail, scans and fax documents, mail distribution

Sterile Technician

Parkland Hospital
Dallas, TX
07.2014 - 08.2015
  • Decontaminated/ sterilized all used instruments and equipment according to departmental policy and the manufactures recommendations while adhering to OSHA guidelines for employee safety
  • Assembled instrument sets according to the count sheets and departmental guidelines while ensuring cleanliness, functionality, and proper set up for sterilization
  • Collected, read, and documented autoclave indicator and biological results to ensure functionality of all sterilization equipment
  • Prepared needed case carts according to pull sheets and specialty carts according to inventory sheets and reports all discrepancies
  • Identified ways to improve the work processes of the Sterile Processing area, and to improve customer satisfaction/internal contacts
  • Makes recommendations to supervisor, implements and monitors results as appropriate in support of the department goals and the mission of Parkland

Case Manager- AA, CSR

Workforce Solutions Greater Dallas
Dallas, TX
06.2008 - 06.2013
  • Interviewed clients to determine eligibility for state resources
  • Investigated customer’s submitted documents to ensure that all items were verifiable and accurate job search contacts
  • Provided job leads based upon the customers’ qualifications
  • Administrative Assistant to the Center Manager keeping confidentiality with all information and correspondence
  • Developed, implemented, and maintained all policies and procedures per company standards

Education

NHA Certified Phlebotomy Technician -

El Centro College
Dallas, TX
01.2019

Diploma and Certified Registered CRCST -

Fortis Institute
Grand Prairie, TX
01.2014

Skills

  • Account management
  • Customer service
  • Data Entry
  • Administrative Assistant
  • HIPAA Compliance
  • CPR and AED Certified
  • Call Center
  • Conflict Management and Resolution
  • Risk Management
  • Leadership Direction
  • Quality Assurance
  • High Level Customer Service
  • Probe and Identify
  • First Call Resolution
  • Scheduling
  • Courteous demeanor
  • Creative problem solving
  • Client relations
  • Schedule mastery
  • Active listening
  • Hospitality and accommodation

Educationandprofessionaldevelopment

  • Texas All Lines Insurance Adjuster
  • NHA Certified Phlebotomy Technician, El Centro College, 2019
  • Diploma and Certified Registered CRCST, Fortis Institute, 2014

Timeline

Customer Service Representative

Aetna at CVS Health
11.2024 - Current

Provider Experience Lead

ChampVA
11.2022 - 03.2024

Patient Care Technician

Premise Health at Lockheed Martin
01.2022 - 10.2022

Administrative Assistant

Premise Health at Goldman Sachs
01.2018 - 01.2022

Customer Relationship Manager II

J.P. Morgan Chase
08.2015 - 01.2018

Sterile Technician

Parkland Hospital
07.2014 - 08.2015

Case Manager- AA, CSR

Workforce Solutions Greater Dallas
06.2008 - 06.2013

NHA Certified Phlebotomy Technician -

El Centro College

Diploma and Certified Registered CRCST -

Fortis Institute

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Nikka Walton