Roselyn Young
Indianapolis,IN
Summary
Trusted and proven Frequent and Repeat Caller Patient Care Advocate with over 10 years in fast-paced customer service and call center environments. Personable and professional under pressure.
Overview
13
13
years of professional experience
Work History
Patient Care Advocate Frequent Caller Team
Accredo Specialty Pharmacy
Indianapolis, Indiana
11.2023 - Current
- Efficiently and effectively resolves frequent caller issues.
- Educates patient on benefits, copayment assistance and prior authorization processes.
- Serves as a liaison between the patient, the prescribing provider and the insurance plan.
- Interacts with both internal and external partners to ensure patient satisfaction.
- Assisted patients in navigating insurance and medication access issues.
Medicare Sales Representative
TTEC
Englewood, CO
08.2020 - 10.2023
- Explained advantages, disadvantages and features of policies to promote sales of Medicare plans
- Provided opportunities for clients to enroll in Medicare Advantage Plans during the 2020 Annual Enrollment Season
- Developed insurance cross-selling opportunities in partnership with Medicare Supplements and stand alone products
- Drove client retention by increasing savings opportunities and identifying premium discounts
- Implemented and designed effective marketing strategies to adjust and sell insurance contracts
- Skillfully and patiently explained coverage options to potential policyholders, answering any questions or concerns
- Held in home sales presentations with prospects
- Analyzed customer needs and provided best options, upselling products and services
Insurance Agent
AIL
Media, PA
09.2019 - 01.2020
Insurance Follow Through Representative
HBCS, Ltd
New Castle, DE
06.2018 - 04.2019
- Developed, implemented and monitored new workarounds and processes for follow up by tracking trends for claim payments based on review of the explanation of benefits and remittance advice
- Successful in drafting appeals and appeal processes that led to denial overturns for both technical and professional charges
- Resolved routine and complex underpayment issues by performing detailed research through the request and interpretation of medical records
- Contacted patients via written or telephonic means to extract information used to assist in claims reimbursement while remaining HIPAA compliant
- Served as a lead, mentor and new hire trainer
- Retained a strong medical terminology understanding in an effort to better comprehend what was involved in procedures
- Ensured that appropriate coding is managed and applied per the payer contract to maximize efficiency and claim payment
- Provided quality customer service to all assigned, insured and claimants throughout claims process to deliver timely service to customers
- Verified details with policyholders and requested additional information
Collegiate Nursing Care Tech
Bayhealth Kent General
Dover, DE
12.2016 - 04.2018
- Direct patient care under the supervision and at the direction of the RN
- Collected biological specimens and packaged for laboratory transport to complete important diagnostic tests
- Performed and documented vitals while assessing patients moods and behaviors
- Reported changes or significant behaviors to the nursing staff
- Provided daily living activities to patients by serving meals, feeding, ambulating and positioning patients
- Provided patient education in oral, written and tactile forms
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems
- Partnered with cash posting team to ensure timely posting of remittances
Senior Claims Adjuster
Dell Services
Plano, TX
04.2012 - 06.2015
- Efficiently and effectively processed a large volume of QNXT medical claims on a daily basis on a remote assignment
- COB trainer for peers and new hires
- Team Lead and SME for high dollar claims adjusting
- Adjusted claims for Commercial, Medicare, Medicaid and Workers Compensation for a Colorado payer
- Inputted data into the system, ensuring that provider coding information and reported services were correct
- Maintained HIPAA compliance across all patient data-handling, systems and training
- Based the payment or denials of medical claims upon well-established criteria for claims processing
Education
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
Hooksett, NHSkills
- Proven de-escalation skills
- Successful case management
- Adept in tracking trends
- Insurance navigation expert
Systems And Databases
- Facets
- CRM
- OpsInsight
- CSP
- RX Home
- ECM
- C-Agent
- Pega
- One Note
- CITRIX
- Sharepoint
Timeline
Patient Care Advocate Frequent Caller Team
Accredo Specialty Pharmacy
11.2023 - Current
Medicare Sales Representative
TTEC
08.2020 - 10.2023
Insurance Agent
AIL
09.2019 - 01.2020
Insurance Follow Through Representative
HBCS, Ltd
06.2018 - 04.2019
Collegiate Nursing Care Tech
Bayhealth Kent General
12.2016 - 04.2018
Senior Claims Adjuster
Dell Services
04.2012 - 06.2015
Bachelor of Science - Healthcare Administration
Southern New Hampshire University