Randi Hughes
Covington,GA
Summary
Hardworking, highly motivated professional eager to lend combined knowledge and skills to enhance business performance. Operates well in both individual and team capacities, leveraging seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven with a passion for growth and efficiency to meet company needs and increase service value.
Overview
14
14
years of professional experience
Work History
ACCOUNTS RECEIVABLE SPECIALIST
Ensemble Health Partners
01.2022 - Current
- Chat with payers via email, web chat, or phone to retrieve payment information, and document it in Epic
- Responsible for following up directly with commercial and governmental payers to resolve claim issues, and secure appropriate and timely reimbursement
- Examine denied and underpaid claims to determine the reasons for discrepancies
- Communicate directly with payers to follow up on outstanding claims, file technical appeals, resolve payment variances, and ensure timely reimbursement
- Identifies and analyzes denials and payment variances, and takes action to resolve accounts, including drafting and submitting technical appeals
- Collaborate and work effectively with other cross-functional teams to gather information for claim processing and payments
- Identifies and analyzes denials and payment variances, and takes action to resolve accounts, including drafting and submitting medical records for technical appeals
- Monitored the status of submitted Medicare claims through payer websites or automated systems
- Adhered strictly to HIPAA regulations while handling confidential patient information during the course of processing their claims
- Assist in completing special projects and other administrative/operational duties assigned
INBOUND CONTACT REPRESENTATIVE
Humana, Inc
08.2021 - 01.2022
- Handled customer inquiries regarding insurance policy coverage details and payment status updates
- Serve as a member advocate, addressing customer needs, which may include acting upon complex benefit needs, resolving grievances, and educating members
- Ensure accurate and timely processing of all requests by taking appropriate action, such as scheduling appointments, taking messages, and transferring calls to appropriate staff
- Resolve patient issues through independent problem-solving, with a goal of first call
- Worked both independently and as part of a team to accomplish work tasks
- Identified trends in customer inquiries to provide insights into areas for improvement within the organization
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor
LOAN SERVICING REPRESENTATIVE
Suntrust Now Truist
11.2020 - 03.2021
- Cross-sell additional banking products, such as loans, and communicate new and existing product offerings and value propositions relevant to the member's account
- Resolves problems and complaints that clients may have about banking products and services
- Mastered client service techniques and referral procedures to enhance customer experience
- Consult with customers to determine the best methods to resolve service and billing issues
- Works within the Loan Service department, assisting customers with non-mortgage loan products and processes
- Handled escalated calls from customers regarding their loans or account activity with tact and diplomacy
- Utilized advanced problem-solving techniques to identify root causes of discrepancies and develop action plans to resolve issues quickly and accurately
- Communicate efficiently with members through multiple channels, establish a professional member relationship, and ensure a positive member experience
- Managed a high volume of incoming calls and emails, professionally and efficiently addressing members' needs
MEMBER CARE REPRESENTATIVE
Snapping Shoals Emc
02.2018 - 08.2020
- Processed service orders, forms, applications, and requests for utility services
- Created and maintained member account information as appropriate
- Acknowledge and resolve member-related concerns, and maintain the confidentiality of member information and documentation.
- Received incoming calls and assigned them to the appropriate departments
- Promptly respond to member inquiries with solutions, and communicate efficiently with members through multiple channels
- Established a professional member relationship, and ensured a positive member experience
COMMUNICATIONS OFFICER/JAILER
Chamblee Police Department
06.2011 - 02.2017
- Answered incoming emergency and non-emergency calls
- Operate a multi-line telephone system.m
- Worked closely with police officers, fire fighters and EMS personnel in order to provide the best possible service for the public's safety needs
- Determine and assign the level of priority of the call to the appropriate personnel.
- Monitor and operate radio console and computer equipment
- Trained new hires on CAD systems and dispatching
- Tracked units and maintained cognizant knowledge of all field units as to their status and location
- Assist the public with any questions and making bond payments
Education
ASSOCIATE IN SCIENCE (A.S.) - BUSINESS ADMINISTRATION/MANAGEMENT
Gwinnett Technical College
05-2027
Skills
- Customer Support Expertise
- Remote Work Experience
- Call Center (epic, genesys, availity, claims)
- Accounts Receivable Management
- Employee Onboarding Expertise
- Developing Customer Rapport
- Microsoft Office applications (Outlook, Powerpoint, excel)
- Data Entry/Customer Service
- Skilled Cross-Functional Communicator
References
Available upon request
Timeline
ACCOUNTS RECEIVABLE SPECIALIST
Ensemble Health Partners
01.2022 - Current
INBOUND CONTACT REPRESENTATIVE
Humana, Inc
08.2021 - 01.2022
LOAN SERVICING REPRESENTATIVE
Suntrust Now Truist
11.2020 - 03.2021
MEMBER CARE REPRESENTATIVE
Snapping Shoals Emc
02.2018 - 08.2020
COMMUNICATIONS OFFICER/JAILER
Chamblee Police Department
06.2011 - 02.2017
ASSOCIATE IN SCIENCE (A.S.) - BUSINESS ADMINISTRATION/MANAGEMENT
Gwinnett Technical College
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