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Member Service Specialist Resume Example

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JB
MEMBER SERVICE SPECIALIST
Professional Summary

Energetic team-player experienced working in high-volume medical practice environment. Skilled in marketing and sales with strong knowledge of medical terminology and prescriptions for wide range of treatments. Strong process management, customer service and communication skills. High-functioning Insurance Representative with successful background in Customer Service. Encourages positive patient experiences through excellent customer service and quality patient care. Coordinates clerical activities to support healthcare team by expertly facilitating patient scheduling, registration and insurance verification procedures.

Skills
  • Insurance coverage verification
  • Patient contact
  • Office administration
  • Insurance Knowledge
  • Team leadership and coaching
  • Training and Development
  • Staff training and development
  • Medical Records Management
  • Prior authorization processing
  • Customer service
  • Product Knowledge
  • Scheduling
  • Relationship building and management
  • Store Management
  • HIPAA Compliance
  • Patient Information Collection
Work History
11/2018 to CurrentMember Service SpecialistGateway Health Plan | Pittsburgh, PA
  • Compliant with all HIPAA, PHI, & CMS guidelines and regulations.
  • Competent knowledge of health plan products, policies, procedures, benefits, & coordination of benefits.
  • Efficiently took inbound calls & made outbound calls to and from health providers, pharmacies, & internal company departments with accurate call documentation.
  • Accurately & urgently communicated member Medical Assistance benefits & guidelines.
  • Analyzed, documented, interpreted, & sorted large amounts of data for business means & for patients' & providers' understanding.
  • Actively & proactively assisting with the internal projects.
  • Assisted with training newly hired representatives & assisted others to complete job tasks while maintaining efficient productivity of my responsibilities.
  • Thoroughly communicated & presented any information internally to management & other peers.
  • Assisted with escalated insurance issues & questions while maintaining regular work duties.
  • Comfortably learned & maneuvered multiple systems and software to effectively complete job tasks including all components of Microsoft Office.
  • Cross-trained and provided back up for customer service managers.
  • Reduced average call time 14% with optimal call control and efficient use of internal knowledge bases.
11/2017 to 03/2019FINISH LINESTORE LEAD | Pittsburgh, PA
  • Assists Store Manager in all aspects of daily shift management, including customer relations, inventory control, procedural tasks and paperwork, as well as visual merchandising.
  • Maintains both individual and shift sales.
  • Provides daily shift floor coverage.
  • Trains Sales Associates.
  • Supervises POS.
  • Provides security & loss prevention in store.
  • Oversees contest management (Tracking Results & Coaching Performance).
  • Organizes shipments, transfers & merchandise.
  • Opens and closes store.
  • Holds accountability for store sales and metrics.
  • Maintains company standards regarding personal and store sales/performance metrics.
  • Trained new associates on cash register operations including opening, conducting customer transactions and balancing drawer.
  • Managed promotional in-store signage and displays and re-stocked merchandise from returns or dressing rooms.
  • Increased sales 17% by offering advice on purchases and promoting additional products.
10/2015 to 02/2017Insurance Verification SpecialistCVScaremark | Monroeville, PA
  • Compliant with all HIPAA & PHI regulations and guidelines.
  • Assisted with claims processing for Pharmacy Medications.
  • Accurately & efficiently obtained patient's insurance and demographic information.
  • Verified both medical and pharmacy benefits for patients' specialty medications.
  • Conducted timely, thorough follow-ups & updates with patients, medical doctor offices & health insurance providers.
  • Managed medication therapy specific & insurance specific projects to decrease & prevent bad debt.
  • Adjusted to any healthcare changes that impacted pharmacy's coverage network.
  • Worked with several Medicaid & commercial insurance policies from several states.
  • Reviewed 175 patient cases per week and verified insurance coverage information
04/2015 to 08/2015Patient Access RepresentativeUPMC WorkPartners | Pittsburgh, PA
  • Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
  • Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
  • Explained estimated cost for medical treatments and answered patient questions to promote good understanding of proposed services.
  • Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
  • Determined patient financial needs and referred eligible patients to proper county, state or federal agencies to obtain financial assistance.
  • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
  • Received patient deductibles, co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
Education
Associate | Human Resources DevelopmentCommunity College of Allegheny County, Pittsburgh, PA
High schoolWestinghouse High School, Pittsburgh, PA
Accomplishments
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Awarded “Employee of the Month” in 2019.
  • Telephone Service - Professionally processed 80+ calls per day, providing information and service to ensure customer satisfaction.
  • Supervised team of 12 staff members.
  • Promoted only 3 month after hiring
  • Attended Nike conference in 2018
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Resume Overview

Companies Worked For:

  • Gateway Health Plan
  • STORE LEAD
  • CVScaremark
  • UPMC WorkPartners

School Attended

  • Community College of Allegheny County
  • Westinghouse High School

Job Titles Held:

  • Member Service Specialist
  • FINISH LINE
  • Insurance Verification Specialist
  • Patient Access Representative

Degrees

  • Associate | Human Resources Development
    High school

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