Dynamic Customer Service Specialist with a proven track record at Lumeris, achieving high satisfaction through effective problem resolution and proactive communication. Skilled in data entry and customer relations, I excel in transforming customer challenges into positive experiences. Trained new hires, showcasing leadership and excellent oral communication abilities.
Overview
12
12
years of professional experience
Work History
Customer Service Specialist
Lumeris
06.2018 - 04.2024
Achieved high satisfaction rating through proactive one-call resolutions of customer.
Provided primary customer support to internal and external customers.
Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions. (Grievance)
Responded to customer requests for products, services, and company information.
Updated account information to maintain customer records.
Responsible for responding to all incoming emails to Customers Service.
Interact with customers to provide information regarding their medical coverage.
Provided training new hires.
Ensured necessary documentation's were obtained for prior authorizations.
Liaison between patients, pharmacies, providers, and medical staff.
Assisted members with finding other providers in network.
Precertification Specialist
Washington University
08.2017 - 02.2018
Increased accuracy of submitted claims through meticulous attention to detail in verifying insurance eligibility and benefits.
Boosted efficiency within the team by regularly updating coworkers on changes in insurance policies or procedural requirements affecting precertifications.
Maintained strict adherence to HIPAA regulations by safeguarding confidential patient information during all aspects of the precertification process.
Enhanced interdepartmental collaboration through effective communication with case managers, physicians, and billing departments.
Conducted thorough follow-ups with insurance companies, ensuring timely receipt of authorization numbers for approved services.
Obtain prior authorization for surgery
Review charts and medical policy for appropriate coverage.
•Verify CPT codes
Medical Assistant/Office Coordinator/ Per Cert Rep
St. Luke's Permier Pain Consultants
03.2012 - 08.2017
Completed clinical procedures and gathered patient data for interpretation by physician.
Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
Sanitized, restocked, and organized exam rooms and medical equipment.
Called and faxed pharmacies to submit prescriptions and refills.
Obtained client medical history, medication information, symptoms, and allergies.
Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
Verified patient insurance coverage and collected required co-payments.
Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Education
Bachelor Of Arts - Healthcare Management
Missouri College
St Louis, MO
05.2015
Medical Assistance
Missouri College
St Louis, MO
05.2010
Skills
Customer Service
Good communication skills
Customer Relations
Call center experience
Excellent written and oral communication
Problem Resolution
Data Entry
Follow-up skills
Microsoft Outlook
Live chat support
Timeline
Customer Service Specialist
Lumeris
06.2018 - 04.2024
Precertification Specialist
Washington University
08.2017 - 02.2018
Medical Assistant/Office Coordinator/ Per Cert Rep