Summary
Overview
Work History
Skills
Timeline
Generic

Valori Anderson

Portland,OR

Summary


Experienced with coordinating and managing appointment schedules for high-demand environments. Utilizing advanced organizational skills and attention to detail to maximize appointment fulfillment and alleviate scheduling conflicts. Strong understanding of communication and client service ensures effective communication and client satisfaction.

Overview

8
8
years of professional experience

Work History

Member Service Representative

Centene, Superior Health Services
08.2022 - 04.2024
  • Assisted State Health Plan/Medi-Cal members with inquiries regarding claims, eligibility, covered benefits, and authorization status.
  • Educated members on available services and health plan options for better decision-making.
  • Assisted with proper claims billing procedures and researched any processing inaccuracies in claim payments. Routed findings to the appropriate team for claim adjustment.
  • Made referrals to other departments, i.e., transportation, case management, appeals, and grievances, as appropriate to allow beneficiaries access to their full State Health/Medi-Cal benefits.
  • Assisted members and providers with website registration and navigation
  • Documented all activities for quality and metrics reporting through the Customer Relationship Management (CRM) software application
  • Utilized multiple computer systems and advanced communications skills to explain complex information clearly and professionally.

Provider Service Representative

Versant
10.2020 - 10.2021
  • Facilitated communication between providers and internal departments, ensuring accurate information exchange.
  • Responsible for the Provider escalation hotline and email queue. Ensured that escalated issues were resolved quickly and effectively, and followed up with all parties involved to turn negative experiences into positive outcomes.
  • Answered calls and responded to emails for the Order Entry technical support desk, ensuring our providers' excellent customer service and educational development.
  • Coordinated via email with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
  • Worked closely with other departments, including Client Administration, IT, Member Benefits, Billing, Claims, and Sales, to ensure provider needs were met while meeting internal objectives.
  • Provided management periodic feedback to recommend process and procedure changes focused on continuous improvement.
  • Quality reviewed optical orders received via fax before submitting them to the lab.
  • Completed daily reports and distributed them to the appropriate departments.
  • Participated in any/all training and educational activities necessary to fulfill requirements to meet departmental goals.
  • Provided training support to new team members, fostering a collaborative work environment.
  • Complied with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) and adhered to all data security guidelines established within the Company's Privacy & Security Training Program.

Patient Services Billing Representative

Verity
08.2019 - 10.2020
  • Complied with HIPAA and all laws, rules, and regulations, for the release of PHI to attorneys, insurance companies, outside providers of health care, and others, as compelled by law or as directed by the patient
  • Responded to internal and external customer billing issues via phone, mail, and other correspondence methods
  • Communicated to the patients our policies on payment of services
  • Utilized a variety of computer systems to extract information regarding diagnosis, procedures, service utilization, length of stay, dates of service, ICD Codes, and provider identification
  • Verified Insurance Eligibility & Benefits
  • Verified Other Coverage Information (OCI), primary, secondary, & tertiary payers for services provided.
  • Conducted follow-ups on denials and filed appeals as appropriate
  • Applied in-depth knowledge of billing rules to investigate and resolve problems related to outstanding insurance and patient accounts.
  • Determined & collected cost-shares, & partial payments for services received.
  • Reviewed past due accounts and identified accounts for collections.
  • Contacted patients to collect past due balances via credit card.
  • Negotiated payment arrangements & referred patients, as appropriate, to financial counselors

Scheduling Representative

Linguava Interpreters
10.2016 - 11.2018
  • Promptly answered calls from clients, projecting a professional image and positive can-do attitude.
  • Utilized customer service training to establish rapport and assisted customers in creating interpreter requests.
  • Maintained knowledge of procedures for both scheduling appointments and assigning interpreters.
  • Assured prompt and accurate dispatch of incoming orders while following procedures to ensure fair and equitable distribution of work and documented properly.
  • Utilized critical thinking and knowledge of interpreters' schedules, preferences, and strengths to maximize coverage of appointments.
  • Conducted outbound calls to clients to provide updates on interpreter assignments.
  • Maintained knowledge of company policies and communicated them to clients with a high degree of accuracy.
  • Communicated with coworkers via email and inter-office chat.
  • Communicated with interpreters via text messages, email, and phone.
  • Consistently met or exceeded performance metrics, demonstrating commitment to excellence in the customer service scheduling role.
  • Adapted quickly to evolving business needs by staying current with best practices in customer service scheduling.
  • Utilized computer software to manage customer information and service scheduling.
  • Demonstrated flexibility in handling unexpected scheduling changes, maintaining a high level of professionalism, and adaptability to ensure a positive experience.

Skills

  • Analytical problem solving
  • Strong written communication
  • Skilled in managing remote workflows
  • Skilled in time management
  • Interoffice communication tools
  • Client relationship management
  • Consistent reliability
  • Troubleshooting and technical guidance
  • Strong attention to detail
  • Healthcare privacy compliance
  • Proficient in organizing tasks
  • Email management
  • Proficient in Google Docs

Timeline

Member Service Representative

Centene, Superior Health Services
08.2022 - 04.2024

Provider Service Representative

Versant
10.2020 - 10.2021

Patient Services Billing Representative

Verity
08.2019 - 10.2020

Scheduling Representative

Linguava Interpreters
10.2016 - 11.2018

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