Stephanie Dumas
Pittsburgh,PA
Summary
Specializing as an advocate member services in a call center environment educates and guides customers through coverages, claims and other program inquiry and policies. Exercising patience and compassionate attention of our members, providers, and facilities on every call, first call resolution. Documenting in transactional systems with active listening. Evaluate and explain components of health insurance coverages by phone calls, chats and web messages following company guidelines. Service your dedicated product line of business while assisting alternate product lines on an as-needed basis by problem solving. Effectively communicate and collaborate through outbound calls across departmental initiatives to manage optimal member care, minimized health risks, to drive and impact goals.
Experienced with patient care and customer service, essential for successful health concierge roles. Utilizes strong interpersonal skills to foster trust and satisfaction among clients. Knowledge of healthcare systems and processes ensures efficient and effective service delivery.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Health Concierge
UPMC Health Plan
03.2023 - Current
- Coordinated patient appointments and follow-ups to enhance service delivery and satisfaction.
- Developed personalized health plans to meet individual client needs and preferences.
- Managed communication between healthcare providers and clients for seamless care transitions.
- Streamlined patient intake processes, improving efficiency and reducing wait times.
- Educated patients on available resources and programs, empowering them to make informed decisions about their health.
- Assisted patients in navigating complex insurance processes, alleviating stress and promoting financial wellbeing.
- Promoted adherence to treatment plans by reminding patients of appointments or medication schedules as necessary.
- Provided compassionate emotional support to patients coping with illness or injury, contributing to their overall wellbeing.
- Resolved conflicts and addressed concerns promptly, fostering a positive environment for patients and staff alike.
- Managed sensitive information with discretion, maintaining strict confidentiality in accordance with HIPAA regulations.
- Coordinated care between multiple departments for seamless transitions and optimal patient support.
- Collaborated with healthcare providers to ensure timely delivery of services, enhancing patient outcomes.
- Maintained accurate records of patient interactions, ensuring effective communication within the care team.
- Developed strong relationships with patients and families, cultivating trust and rapport for better engagement in the care process.
- Maintained full and current understanding of available plans, products and services.
Case Management Analyst
Cigna Healthcare
09.2011 - 04.2021
- Served as initial contact for customers in Inbound Queue. Documented HIPAA Privacy, Recording Disclaimers and Safety Disclaimers. Presented client specific information procedures staff and members. Analyzed results for trends, evaluated, and reviewed SOPs for quality and account effectiveness.
- Recognized with Cigna Standard and Cigna Champion Awards, met goal challenges
- Flexibility in schedules
- Highly organized, work good organizational skills
- Achieved training in One Guide and Knowledge Exchange.
- 100% Collaborated with Health Educators, Nurses, Behavioral Clinicians, and Providers.
- Conducted provider searches for INN/ONN Benefits in One View & ICMS and verify Benefits in INN/ONN.
- 100% Utilized clinical triggers to identify cases for the Case Management Program.
- 60 % Executed Pre-Admission / Post Discharge, HCC/HAM, CCMU Engagements/Enrollments.
- 100% Assigned and assessed customers need to link them to behavioral network providers for assessment and counseling.
- Created Authorization for EAP Referrals/Authorizations.
- Support Health Coaches Workflow
- Attended client meetings to impact program effectiveness.
Education
Bachelor of Science (BS) - Social Work
California University of Pennsylvania
12-1989
Skills
- Engagement Coaching
- Case Management
- Explanation of Benefits
- Collaboration
- Provider Searches/Community Resources
- Authorizations
- Proficient Typing
- Medical/Clinical Care
- Effective Communication
- Excellence in Customer Service
- Proficient Writing Skills
- Analytical Skills
- Microsoft excel
- Microsoft PowerPoint
- Microsoft Word
- Microsoft Office
- Operating Systems
- Benefits and Claims Resource
- Provider Searches
- Cogito
- Auto Dialer
- Cisco
- One Guide
- Cams
- HEV
- Ren
- ICMS
- Spread Sheet
- Insurance verification
- Patient confidentiality
- Appointment scheduling
- Healthcare
- Customer assistance
- HIPAA compliance
- Mental health awareness
- Customer support
- Clinical documentation
- Health promotion
- Care coordination
- Medication management
- Inbound call management
- Call center operations
- Health education
- Research
- Chronic disease management
- Detailing plans
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Punctual and hardworking
- Problem-solving abilities
- Calm and effective under pressure
- Multitasking
- Excellent communication
- Critical thinking
- Registration and scheduling
- Team collaboration
- Active listening
- Effective communication
- Verbal and written communication
- Decision-making
- Detail-oriented
- Documenting and recording information
- Patient education
- Insurance verifying
- Communicating to patients and families
- Patient confidentiality and data security
- Resolving problems
- Patient documentation
- Patient registration
- Medical insurance
- Insurance authorizations
- Scheduling appointments
- Documentation skills
- Organized and detail oriented
- Outbound calling
- Medical terminology
- Interpersonal skills
- Customer relationship management
- Analytical thinking
- Benefits explanation
- Conflict resolution
- Computer literacy
- Risk assessment
- Professionalism
- Crisis intervention
- Medical history documentation
- Patient advocacy
- Patient intake
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Resolved product issue through consumer testing.
- Achieved enrollment through effectively helping with onboarding new members and maintaining memgers.
Certification
Six Sigma White Belt
compliance trainings
VOLUNTEER / COMMUNITY SERVICE
Cigna, Created Monthly Health and Wellness History Vision Board Displayed on Advocate Board Onsite, Wellness Programs and Fundraiser, AA/EB ERG Member, Cigna., Zeta Phi Beta Sorority, Pittsburgh, Best Committee for Employee Moral and Cigna Recognition
Languages
Spanish
Limited Working
Timeline
Health Concierge
UPMC Health Plan
03.2023 - Current
Case Management Analyst
Cigna Healthcare
09.2011 - 04.2021
Bachelor of Science (BS) - Social Work
California University of Pennsylvania