Sandra Grass
Milton,Florida
Summary
Professional advocate with extensive experience in customer service and conflict resolution. Known for delivering impactful solutions that improve customer experiences. Strong focus on team collaboration and adaptability, consistently supporting dynamic needs and achieving results.
Overview
29
29
years of professional experience
Work History
SA-IV Service Advocate
Florida Blue
12.2018 - Current
- Familiar with and abide by HIPAA law
- Provide customer service to providers in a call center setting by answering benefit questions, researching and resolving issues and inquiries, and ensuring providers understand the Company’s products and services
- Educate providers on Availity self-service tools, authorization timeframes, referral requirements and other authorization/referral questions as needed
- Act as a liaison between hospitals, physicians, health plans, vendors, patients or referral sources
- Daily use of Outlook, Jiva, Provider Connect, Care Connect, Aspect, Diamond and Siebel
- Work with providers, initiating requests for authorizations or referrals
- Verify insurance coverage; assist providers to the correct plan for BlueCard HOST members
- Enter referrals/authorizations and thoroughly document communications, actions and other data in departmental systems
- Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient certification and/or prior authorization requests
- Refer cases requiring clinical review to appropriate clinical professionals
- Provide guidance and expertise to less experienced Service Advocates
- Evaluate authorization requests to determine eligibility for administrative approval using established guidelines, including researching Medical Coverage Guidelines and plan benefits
- Proficient in completing additional work types outside of basic phone duties, including Out of Network Ambulance and Lab reports, Light Reviews, Admin Support, CareCentrix Redirect report, NON PAR report and Genetic Pilot report. These reports require skills in researching eligibility, benefits, provider contracting and medical coverage guidelines
Front Desk Manager/Associate
Brett/Robinson
10.2012 - 07.2018
- Responsible for Owner and Guest assistance
- Customer service, to include… (booking/modifying reservations, resolving customer complaints, what else?)
- Responsible for cash and credit transactions
- Boat slip rental assistance
- Parking assignment
- Housing resolution assistance – what does this mean?
- Daily use of office equipment including Fax, Scan and Data entry
- Responsible for payroll for xx employees, including time sheet entry, vacation coding, etc.?
- Scheduling of xx employees, including office staff, housekeeping maintenance, etc.?
- Organizing special events for guests, including …
- Bank Transactions (daily deposits, paying bills?)
- Daily Audits of…
- Problem solving – what types of problems
- How can you equate this experience to being a liaison between parties
- How can you demonstrate your ability to problem solve and find positive solutions?
Medical Records Technician
Cardiology Consultants
05.2008 - 12.2010
- Familiar with and abide by HIPAA law
- Daily use of office equipment including but not limited to Fax, Data entry and copy machines
- Responsible for handling multi-line phones, inventory, filing, chart prep, new patient charts, electronic records and physician dictation corrections
- Responsible for all subpoenas, insurance, death certificates, living wills and patient requests
- Responsible for physician consults
- Work in an office environment assisting fellow employees
- Responsible for incoming/outgoing mail
- Daily interaction with patients, two consistent and two intermittent physicians and their respective files and records
- Chart Analysis
- Responsible for scanning charts and other information into the electronic system.
ROI Assistant
Southern Records Management
09.2005 - 05.2008
- Familiar with and abide by HIPAA law
- Daily use of office equipment
- Responsible for handling inventory, multi-line phones, filing and copying medical records
- Daily interaction with patients and their respective files and records
- Work in an office environment assisting fellow employees
- Responsible for making bank deposits.
Professional Housekeeper
Self Employed
01.2002 - 08.2005
- Cleaning of personal residences, construction areas, condominiums and small businesses
- Required duties included heavy lifting, chemical awareness, personal time management, general and deep cleaning skills and orchestrating management of schedules
- Problem solving
- Customer satisfaction
- Maintained xx contracts over yy years with multiple referrals to new business??
Sales Executive
PC Marketing
02.1996 - 08.2001
- Warehouse experience included heavy lifting, inventory management and accountability
- Responsible for call quota attainment and resulting telephone sales
- Resolving customer service issues, such as
- Responsible for equipment and product sales to salon owners, retail sales to private customers and storefront sales
- Responsible for cash management and tasks such as answering multi-line phones, filing customer files, faxing, data entry and bank deposits.
Education
GED -
Jefferson State Community College
Skills
- Account Updating
- Data Collection
- Customer Support
- Documentation and Reporting
- Eligibility Determination
- Data Entry
- Problem Solving
Timeline
SA-IV Service Advocate
Florida Blue
12.2018 - Current
Front Desk Manager/Associate
Brett/Robinson
10.2012 - 07.2018
Medical Records Technician
Cardiology Consultants
05.2008 - 12.2010
ROI Assistant
Southern Records Management
09.2005 - 05.2008
Professional Housekeeper
Self Employed
01.2002 - 08.2005
Sales Executive
PC Marketing
02.1996 - 08.2001
GED -
Jefferson State Community College
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