Customer Care Advocate - Oak Street Health, part of CVS Health - Remote
(2026-01)
- Schedules and coordinates Medicare patient appointments, optimizing provider schedules and operational efficiency.
- Confirms patient appointments and maintains accurate scheduling records to support seamless clinic operations.
- Processes and submits referral requests to healthcare providers, ensuring timely access to necessary medical services.
- Coordinates and transmits patient referrals to specialists, facilitating prompt continuity of care.
- Assists patients with appointment scheduling, referrals, and care coordination to enhance the patient experience.
- Collaborates with providers to obtain and manage patient documentation, ensuring compliance with healthcare regulations and organizational standards.
- Delivers professional and compassionate customer service, resolving routine inquiries and addressing patient concerns in a timely manner.
- Maintains effective communication with patients, providers, and healthcare teams to support quality care delivery and positive outcomes.
Patient Care Coordinator III - Centene - Absolute Total Care Medicaid - Remote
(2025-04 - 2025-11)
- Collaborated with healthcare providers and teams to develop and implement individualized patient care plans.
- Coordinated follow-up appointments and monitored patient adherence to treatment plans, supporting positive health outcomes.
- Addressed patient questions, concerns, and service issues promptly, enhancing patient satisfaction and trust.
- Created a welcoming and supportive environment for patients, families, and staff, contributing to a positive healthcare experience.
- Maintained strict compliance with HIPAA regulations by safeguarding patient confidentiality and sensitive information.
- Managed and updated patient information within (EHR) systems.
- Prepared, reviewed, and submitted documentation in a timely and accurate manner to ensure regulatory and organizational compliance.
- Routed clinical communications and documentation to appropriate care team members to support efficient workflow and continuity of care.
- Provided administrative and care coordination support to promote effective communication between patients and healthcare teams.
HEDIS Service Associate II - Elevance Health (Anthem) - Remote
(2023-01 - 2025-04)
- Built strong working relationships with healthcare providers through proactive communication and follow-up.
- Secured and tracked medical records from provider offices and hospitals, ensuring timely submission for quality and compliance reviews.
- Verified and updated patient and provider data to maintain accurate records and support data integrity.
- Collaborated with providers to identify and correct diagnosis coding issues, facilitating accurate claims processing and reducing delays.
Data Entry Hospital Claims Analyst - Recruiting Solutions - Remote
(2022-02 - 2023-01)
- Investigated and resolved denied medical claims while ensuring regulatory compliance and accuracy.
- Reviewed documentation to support successful claim appeals and timely resolutions.
- Processed appeals and communicated claim decisions to healthcare providers.
- Researched claim denials by contacting hospitals and provider offices for clarification.
- Utilized claims management software to track claims and appeal activity.
- Monitored filing deadlines to ensure timely claim resubmissions and appeals.
- Applied knowledge of Medicare, Medicaid, commercial insurance, HIPAA regulations, and medical terminology to support accurate claims processing.
Customer Service Representative - Sitel - Spartanburg, SC
(2016-01 - 2021-12)
- Provided outstanding customer support by resolving customer concerns efficiently while maintaining a high level of satisfaction.
- Managed high-volume customer communications across multiple channels, consistently meeting or surpassing key performance indicators.
- Developed strong customer rapport through effective communication, active listening, and solution-focused problem solving.
- Utilized CRM tools to accurately track customer interactions, ensuring detailed records and consistent follow-up.
- Supported onboarding and training initiatives for new representatives, contributing to improved service quality and operational effectiveness.
- Stayed informed on company products, services, policies, and promotions to deliver accurate guidance and support.
- Handled challenging customer situations with professionalism, employing conflict-resolution techniques to achieve successful outcomes.
