- Visually Inspect each page of medical records for completeness and legibility
- Handle a high volume of continuous records
- Ensure proper documentation is included in each record as directed by client
- Remove pages from records that are not required or non-medical
- Advises clients of benefits and eligibility analysis of their policy plan
- Medical claims issue handling in addition to reviewing and adjusting
- Creation of prior authorization for inpatient and outpatient procedures
- Provided vendors with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes.
- Managing and assisting the team of 10-15 peoples to achieve their target.
- Providing process advise to customer service agents.
- I have also worked as Training Specialist (3 months) where I’ve given process and comm training to new associates
- I have worked as Quality Analyst (2 months) and tracked quality and utilization methods by monitoring the error and process gaps closely.
- Providing formal and informal feedback to the agents to improve productivity and performance.
- Review records or reports pertaining to activities such as monitor work activities, or evaluate performance.
- Critically monitored customer service operations to assess agent performance and provide evaluations and feedback.
- Effectively communicated with different departments through use of strong listening, open-ended questioning and appropriate response skills.
- Coached team members to deliver hospitable, professional service while adhering to set service models.
- Helped employees with day-to-day work and complex problems by applying motivational and analytical strategies.
- Supervised and guided new employees and responded quickly to questions, which improved understanding of job responsibilities.
- Supported senior management in executive decision-making by drafting informative reports.
senior resolution specialist
- Act as supervisor on escalated calls
- Assist agents with resolving customer complaints or answer customers’ questions regarding policies and procedures.
- Take all incoming calls in a high call volume call center
- Experience in AS400(Rxclaims)
- Very knowledgeable of HIPAA (Health Insurance Portability and Accountability Act and Medicare Part D
- Navigate multiple system
- Notate every inbound call with detailed notes