Patricia Wade
Nampa,ID
Summary
Dedicated healthcare customer service professional with extensive experience in patient support, call center operations, and care coordination. Adept at assisting members with healthcare benefits, scheduling, claims resolution, and navigating provider networks. Recognized for delivering empathetic, high-quality service while ensuring HIPAA compliance and adherence to Medicare and TRICARE regulations. Strong ability to problem-solve, multitask, and collaborate with cross-functional teams to improve patient experiences and care outcomes.
Overview
14
14
years of professional experience
Work History
TRICARE Customer Service Representative
TriWest/Chenega Corporation
11.2024 - 01.2025
- Assisted Medicaid and TRICARE members with benefits inquiries, PCP changes, ID card replacements, and transportation coordination
- Provided accurate eligibility, coverage, and claims details to members and providers
- Maintained HIPAA compliance while handling high call volumes and ensuring first-call resolution
- Escalated complex billing and claims issues for expedited resolution
VACCN Appointment Scheduling CSR
Tria Federal / Optum Healthcare
11.2023 - 05.2024
- Scheduled medical and dental appointments for Medicaid STAR+PLUS and Veteran members
- Managed high-volume inbound calls, educating members on provider networks and coverage details
- Verified and updated Medicaid records and eligibility in scheduling systems
- Assisted members in navigating Medicaid STAR+PLUS services and benefits
Correspondence Phone Support / Concierge
Blue Shield of California
10.2020 - 04.2023
- Provided MCO insurance support, assisting Medicaid members with claims resolution, benefits inquiries, and provider referrals
- Educated members on STAR+PLUS program coverage, ensuring a clear understanding of plan options
- Processed claims and ensured accurate documentation for compliance
- Resolved complex billing concerns by coordinating with insurance providers
IHSS Service Desk
Experis IT
07.2020 - 10.2020
- Supported IHSS clients by verifying eligibility, coordinating service scheduling, resolving inquiries, and maintaining accurate records.
- Assessed client eligibility based on medical and income criteria, gather required documentation, and complete intake forms.
- Assisted clients in selecting providers, schedule service hours, and manage updates as needed.
- Addressed inquiries related to services, billing, and provider concerns, escalating complex issues when necessary.
- Maintained accurate records of client interactions, service requests, and provider details.
- Ensured adherence to program regulations, confidentiality standards, and participate in training to stay updated on best practices.
Patient Service Representative - Outbound
TriWest Healthcare Alliance
10.2015 - 05.2020
- Conducted proactive outreach to Medicaid & TRICARE members, addressing healthcare needs and coordinating appointments
- Trained new hires on Medicaid call center operations, improving team performance and service quality
- Assisted members with claims inquiries, billing disputes, and provider coordination
Call Center Representative - Inbound
Xerox Healthcare
West Sacramento, USA
11.2014 - 10.2015
- Answered an average of 40-60 calls per day; performed a multitude of diverse searches for Medi-Cal providers, including claims status, appeals and grievances, and TAR status
- Resolved pharmacy claims rejections and escalated claims and appeals as appropriate
- Educated providers on the various activities available to them on the Medi-Cal website
Call Center Representative
HealthNet
03.2014 - 09.2014
- Handled high-volume inbound calls, assisting members with health insurance inquiries, benefits, and claims.
- Explained coverage details, including deductibles, copayments, and out-of-pocket costs.
- Verified member eligibility, processed claims, and managed referral authorizations.
- Guided members in navigating the healthcare system, including provider selection and appointment scheduling.
- Maintained accurate records of interactions and ensured timely issue resolution.
- Addressed customer concerns professionally, escalating complex cases as needed.
Tier 1 Tech Support
Apple
01.2011 - 01.2012
- Provided technical support via calls, chats, and emails for iOS device issues ensuring efficient troubleshooting and resolution.
- Diagnosed common problems, including connectivity, app crashes, updates, battery life, and hardware concerns.
- Delivered clear explanations of iOS features, settings, and functionality to enhance customer experience.
- Utilized Apple's internal tools and resources to provide accurate solutions whileadhering to support procedures.
- Maintained professionalism, actively listened to customer concerns, and communicated solutions in a user-friendly manner.
- Escalated complex issues to higher-tier support teams when necessary.
- Stayed updated on iOS updates, features, and product releases to provide informed assistance.
Education
High School Diploma -
Sacramento Adventist Academy
Carmichael, CA06-1983
Skills
Healthcare Customer Support
Call Center Operations
Patient Education
Care Coordination
Claims Processing
Billing Resolution
Extensive knowledge and experience working with CPT and HCPCS codes
Familiarity with Medicare and Medicaid Federal and State guidelines and regulations
HIPAA Compliance
Medicare Compliance
Data Entry
Accurate Documentation
Appointment Scheduling
Provider Liaison
CRM
Healthcare Platforms
Empathetic Listening
Active Listening
TriZetto Facets
MedNet
HSRM
Salesforce
Zipari
Arvato Vision
Vet Connect
Avaya
Aspect
MiCollab
Amazon Web Connect
Microsoft Office Suite
Word
Excel
Outlook
Scheduling
Account updating
Researching
Conflict resolution
Timeline
TRICARE Customer Service Representative
TriWest/Chenega Corporation
11.2024 - 01.2025
VACCN Appointment Scheduling CSR
Tria Federal / Optum Healthcare
11.2023 - 05.2024
Correspondence Phone Support / Concierge
Blue Shield of California
10.2020 - 04.2023
IHSS Service Desk
Experis IT
07.2020 - 10.2020
Patient Service Representative - Outbound
TriWest Healthcare Alliance
10.2015 - 05.2020
Call Center Representative - Inbound
Xerox Healthcare
11.2014 - 10.2015
Call Center Representative
HealthNet
03.2014 - 09.2014
Tier 1 Tech Support
Apple
01.2011 - 01.2012
High School Diploma -
Sacramento Adventist Academy