Nina Barnes
Compassionate and detail-oriented Healthcare Customer Support Specialist with 6 + years of experience in remote healthcare call centers, pharmacy, patient advocacy, member services, and clinical support. Skilled in customer satisfaction, patient relations, claims resolution, benefits support, and healthcare compliance (HIPAA, PHI, PII, GDPR, CMS). Adept at handling high-volume patient inquiries (50-70 daily) via phone, chat, and email support, consistently achieving 95%+ first contact resolution (FCR) and exceeding CSAT goals by 5%. Experienced with EHR/EMR systems (Epic, Cerner, Athenahealth, Meditech) and CRM/ticketing platforms (Zendesk, Salesforce, Freshdesk, ServiceNow). Known for empathy, active listening, and de-escalation techniques to improve the patient journey while ensuring compliance and accuracy. Dedicated to delivering exceptional member service experiences in healthcare support environments & pharmacies.
Work History
Process Assistant (Manager)
2 Years 7 Months- Created comprehensive training modules for new employees, focusing on adherence to safety protocols and quality benchmarks.
- Assessed performance metrics to enhance operational efficiency and drive continuous improvement initiatives across processing teams.
- Managed scheduling and allocation of tasks to ensure maximum productivity and efficiency during high-demand periods.
- Implemented and reinforced safety protocols to uphold compliance with organizational standards.
Medicare Claims Processor
2 Years- Processed Medicare claims with a focus on accuracy and compliance to ensure timely reimbursement and minimize denials.
- Reviewed and verified prior authorization claims to confirm eligibility and adherence to Medicare guidelines.
- Communicated effectively with patients and providers to clarify claim statuses and resolve billing inquiries.
- Maintained up-to-date knowledge of Medicare policies and prior authorization requirements to ensure regulatory compliance.
Member Service Specialist
2 Years- Educated members on benefits, coverage details, and prior authorization procedures to empower informed healthcare decisions.
- Utilized advanced CRM systems to document member interactions, track authorization statuses, and maintain up-to-date records.
- Collaborated with healthcare providers and insurance companies to facilitate seamless prior authorization approvals and expedite patient care.
- Handled high-volume calls with professionalism and empathy, consistently achieving performance targets and positive member feedback.