Taylor Harris

Medicaid Benefits Management

-Utilized Sales Force: Leveraged Sales Force platform to assess Medicaid members' benefits and coverage, ensuring accurate information dissemination.
-Educational Outreach: Proactively educated members on managing and maintaining their benefits and coverage, empowering them with self-service options for greater autonomy.
-Efficient Ticket Escalation: Facilitated Medicaid member's medical assistance enrollment by promptly escalating tickets within internal departments, ensuring timely resolution and service delivery.

CRM Navigation and Customer Service

-CRM Systems Navigation: Proficiently navigated multiple CRM systems to determine member's benefit eligibility and plan details, streamlining processes and enhancing efficiency while delivering empathetic customer service.

Client Interaction and Communication

-Prompt Verification and Communication: Initiated timely communication with medical facilities to verify client tissue biopsy samples, ensuring accuracy and compliance.
-Efficient Data Management: Utilized Q-Suite software to transmit patient laboratory results to clients promptly and securely, optimizing communication channels.

Process Improvement and Collaboration

-Operational Streamlining: Played a key role in creating and revising Standard Operating Procedures (SOPs) to enhance operational efficiency and ensure regulatory compliance.
-Tailored Solutions Development: Designed customized ordering requisition forms to meet specific client needs, enhancing workflow efficiency and client satisfaction.

Administrative Support

-Sales Collaboration: Collaborated closely with the sales team to provide up-to-date laboratory information to medical facilities, aligning with client expectations.
-Mail Handling and Administrative Support: Managed high-volume client correspondence, including stuffing, posting, and sealing client/patient letters, as well as filtering and delivering incoming mail to appropriate departments.

Client Support and Communication

-Comprehensive Client Support: Managed client inquiries, complaints, billing questions, and payment/service requests with professionalism and efficiency.
-Accurate Benefit and Claims Information: Provided precise information regarding client benefits and claims, ensuring clients are well-informed and satisfied.

Policyholder Assistance

-Explanation of Benefit Guidance: Assisted policyholders in understanding Explanation of Benefit summaries, fostering clarity and comprehension.
-Mail Distribution: Occasionally dispatched client benefit information to physical addresses, ensuring reliable delivery of essential documents.

Interdepartmental Collaboration

-Prior Authorization Coordination: Collaborated with internal departments to facilitate the accurate release of prior authorization for covered benefit services, ensuring seamless service provision.

Pharmacy Support and Policyholder Assistance

-Direct Communication with Pharmacists: Engaged directly with pharmacists and pharmacies to facilitate the removal of medication holds, ensuring timely access to necessary medications.
-Interpretation of Pharmacy Reject Codes: Proficiently interpreted pharmacy reject codes to assess and facilitate the release of requested medications, minimizing delays and ensuring efficient service.

Policyholder Guidance

-Explanation of Benefit Assistance: Provided clear and comprehensive assistance to policyholders in understanding Explanation of Benefit summaries, fostering transparency and understanding.

Interdepartmental Coordination

-Prior Authorization Management: Collaborated with internal departments to ensure the accurate release of prior authorization for covered benefit services, maintaining compliance and facilitating seamless service provision.