Denise M. Jones
Indianapolis
Summary
Customer Care Representative with extensive experience at Elevance, specializing in claims processing and medication authorization. Proven ability to improve workflow efficiency and build strong relationships through effective communication and problem-solving. Dedicated to providing exceptional service and ensuring member satisfaction in high-pressure environments. Over twenty-five years of experience, as well as being, cross-training across multiple business lines, including Commercial and Medicare Advantage plans, with involvement in special growth projects.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Customer Care Representative
Elevance Acquired / IU Health Plans
Indianapolis
11.2023 - Current
- Cross-training for the multiple lines of business, commercial, and Medicare Advantage
- Answered phone lines, providing prompt assistance to members and providers.
- Reviewed benefits and claims with members and providers for accuracy.
- Prioritized daily tasks to enhance workflow efficiency.
- Contacted collections agencies to resolve outstanding member bills.
- Searched for authorizations related to procedures and testing as needed.
- Called pharmacy services for timely medication authorizations.
- Utilized EMR system Cerner to schedule appointments for members.
- Collaborated on special projects and submitted escalations for review.
Front Office Assistant
IU Health Glendale
Indianapolis
06.2023 - 11.2023
- Answered phone, scheduled patients
- Greeted patients
- Updated patient charts
- Take patients vital signs, prep for procedures, draw blood, and obtain specimens
- Updated patient charts in Mysis EMR system
- Maintain and set up patient rooms
- Schedule referrals
Customer Service Representative
IU Health Pathology
Indianapolis
02.2022 - 06.2023
- Worked special projects for opportunities for growth.
- Answered phone lines to address inquiries and provide assistance.
- Reviewed lab orders submitted by providers to ensure accuracy and compliance.
- Prioritized daily tasks to enhance workflow efficiency.
- Handled special projects to support departmental goals.
- Utilized Cerner EMR system for member scheduling and data management.
- Retrieved member data using multiple programs to facilitate information access.
- Cleared and indexed faxes into member charts for organized record-keeping.
Customer Service Representative
IU Health Plans
Indianapolis
12.2017 - 02.2022
- Cross-training for the multiple lines of business commercial & Medicare Advantage along with special projects for opportunities for growth.
- Handled incoming phone calls to resolve member inquiries promptly.
- Evaluated benefits with providers and members to ensure clarity.
- Collaborated with collections agencies to manage outstanding bills for members.
- Prioritized tasks daily, enhancing overall productivity.
- Sourced medication authorizations through pharmacy services to support member needs.
- Utilized EMR system Cerner for effective scheduling of member appointments.
- Assisted in escalations for ticket resolution in Cherwell system.
- Investigated claims and authorizations within HealthRules to streamline processes.
Medical assistant/ Phlebotomist
Appletree Staffing
Carmel & Fishers
03.2014 - 04.2014
- Order labs and process specimens
- Prioritize client care and schedule appointments
- Phlebotomy daily and vital signs when needed.
- Utilize PC to enter and retrieve patient data
- Utilize Quick Books to enter charges
- Answer multi-line phone, operate fax and copy machine
Medical assistant
American Health Network
Indianapolis
09.2009 - 01.2014
- Order lab work and x-rays
- Prioritize patient daily care according to acuity and scheduled patient procedures
- Take patients vital signs, prep for procedures, Phlebotomy, and obtain specimens
- Updated patient charts in NextGen EMR system
- Maintain and set up patient rooms
- Perform EKGs
- Utilize PC to enter and retrieve patient data
- Answer multi-line phone, operate fax and copy machine
Back/front office Medical Assistant
Indiana Neuroscience Associates
Indianapolis
07.2004 - 09.2009
- Answered phone, scheduled patients
- Greeted patients
- Updated patient charts
- Take patients vital signs, prep for procedures, draw blood, and obtain specimens
- Updated patient charts in Mysis EMR system
- Maintain and set up patient rooms
- Schedule referrals
- Refill medications
Education
Medical assistant diploma -
Professional Careers Institute
Indianapolis, IN04.2000
Skills
- Customer service
- Claims processing
- Medication authorization
- EMR system usage
- Data management
- Task prioritization
- Benefit verification
- Communication skills
- Problem solving
- Collaboration skills
- Attention to detail
- Workflow efficiency
- Patient scheduling
- Cross-training
- Appointment scheduling
- Punctuality and reliability
- Verbal and written communication
- Product knowledge
- Custom order management
- Stress management
- Issue follow up
- Issue escalation
- Active listening
- Phone etiquette
- Customer relations
- Time management
- Empathy and patience
- Email communication
- Relationship building
- Call center experience
- Call logging
- Inbound customer service
- First call resolution
- Conflict mediation
- Complaint handling
- Documentation and reporting
- Cultural awareness
- Claims monitoring
- Quality assurance
- Payment processing
- Adaptability and flexibility
- Multitasking and organization
- Email correspondence
- Call handling
- Problem resolution
- Conflict resolution
- Problem-solving skills
- Salesforce CRM
- Calm under pressure
- Information gathering
- De-escalation techniques
- Receiving support
- Team building
- Inquiry response
- Data entry accuracy
Certification
CPR Certified, since 2013 -Current
References
- Phylese, Stephens, 317-496-4791, 7234 River Walk Dr. Apt. F, Indianapolis, IN, 46214
- Mia, Nelson, 317-628-9636, 4716 Roundlake Road, Indianapolis, IN, 46205
- Monique, Dye, 317-941-5054, 2865 Strauss Ln., Indianapolis, IN, 46239
Languages
English
Professional
Salary
Negotiable
Timeline
Customer Care Representative
Elevance Acquired / IU Health Plans
11.2023 - Current
Front Office Assistant
IU Health Glendale
06.2023 - 11.2023
Customer Service Representative
IU Health Pathology
02.2022 - 06.2023
Customer Service Representative
IU Health Plans
12.2017 - 02.2022
Medical assistant/ Phlebotomist
Appletree Staffing
03.2014 - 04.2014
Medical assistant
American Health Network
09.2009 - 01.2014
Back/front office Medical Assistant
Indiana Neuroscience Associates
07.2004 - 09.2009
Medical assistant diploma -
Professional Careers Institute
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