N'Kenge Lee

• Assisting customers with toll road billing inquiries
• Providing dates, times, and locations for tolls
• Providing payment options to customers
• Demonstrated empathy in handling difficult situations, fostering trust and loyalty among customers.
• Effectively managed escalations from dissatisfied customers, working closely with management to ensure timely resolutions that maintained brand reputation.

• Assisting Medicare members via inbound calls with monthly plan premium inquiries
• Locating providers for the members
• Providing information for dental, prescription drugs, and vision services that are covered under Medicare part C as well as the gym memberships and transportation services
• Optimized production quality by identifying bottlenecks and developing targeted solutions.

• Provided coverage details for consumer
• Submitted prior authorizations for outpatient/inpatient services
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.

• Manage physician information by correcting irregularities with information
• Corrected NPI, TAX ID, billing address, etc
• Rendered physician contracts for services wanted to be covered/completed
• Managed service links for other billing service outliers
• Spoke to providers about contractual agreements and coverage guidelines
• Reduced errors in provider data management by introducing automated verification tools.
• Streamlined provider data management through the development of automated systems and tools.

Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.

• Assisted management in updating internal policies related to claims adjudication processes for increased efficiency and effectiveness.

• Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing
• Initiate entry or change of provider related database information
• Develop relationships with providers by coordinating pay schedules such as (DRGs, Bundle payments, Fee for service, RVU, and Capitations)
• Process authorizations for DME, PDN, Long term care, Adult Day Care, Home Health and Personal Care Services
• Priors approve Inpatient/Outpatient/Ambulatory/Office procedures
• Help establish a new working tool to ensure medical requests are received and properly handled

• Assisted providers with claim explanation
• Provided breakdown on claim information and member's responsibility
• Explained the denial reasons for claims and explanation of appeal right
• Provided benefits for services being done in office, outpatient, inpatient, physical therapy, co-pays, and deductibles

• Answered eligibility questions including effective dates, premium payments, and billing
• Adhered to HIPAA regulations
• Explained claim details to both providers and members
• Processed medical claims and sent information back to providers for claims