Alyssa R. Email & Phone Number

Texas, United States

➢ Demonstrate strong communication skills, including the ability to articulate complex claims to medical professionals.➢ Constantly identify and asses the caller’s needs.➢ Acts as a single point of contact for HCP; explains plan of benefits, member rights andresponsibilities in accordance with contracted arrangements.➢ Provide facilities, doctors and other healthcare professionals with accurate informationregarding effective dates of coverage, claims history, medical… Show more ➢ Demonstrate strong communication skills, including the ability to articulate complex claims to medical professionals.➢ Constantly identify and asses the caller’s needs.➢ Acts as a single point of contact for HCP; explains plan of benefits, member rights andresponsibilities in accordance with contracted arrangements.➢ Provide facilities, doctors and other healthcare professionals with accurate informationregarding effective dates of coverage, claims history, medical benefits and deductible andcopay benefits.➢ Interacting with providers, clinicians, pharmacists, and many others professional to providetotal satisfaction and resolutions.➢ Advise clients of their claim related obligations under the policy and establish specific claimsmanagement procedures.➢ Entered and retrieve information of varying complexity using appropriate computer systemapplications to update records.➢ Provide accurate, and complete information in a prompt professional manner.➢ Adhere to claims processes and procedures.➢ Takes immediate action when confronted with a problem or made aware of the situation.➢ Resolves issues without or with limited management intervention. Show less

The Woodlands, Texas, United States

➢ Top Rated in Customer Service➢ A critical thinker, self-management, leadership skills and 5+ years of case managementexperience.➢ Demonstrate adherence to Reed Group values and performance guidelines.➢ Ongoing maintenance/management of information ➢ Oversee case management responsibilities (averages 100-500)➢ Correlating with Human Resources representatives , pay advising specialist , workerscompensation coordinators to ensure cases are processed accurately and… Show more ➢ Top Rated in Customer Service➢ A critical thinker, self-management, leadership skills and 5+ years of case managementexperience.➢ Demonstrate adherence to Reed Group values and performance guidelines.➢ Ongoing maintenance/management of information ➢ Oversee case management responsibilities (averages 100-500)➢ Correlating with Human Resources representatives , pay advising specialist , workerscompensation coordinators to ensure cases are processed accurately and effectively.➢ Strong communication skills to interact with clients or third parties regarding project workor to develop the relationship.➢ Ensure compliance and proper documentation in regard to applicable laws , regulations andplans , including HIPAA, FMLA , Short Term Disability , individual State Leave Acts andcompany sponsored leave programs.➢ Compose notices/correspondence to employees and subcontractors regarding requiredpaperwork, expiring documentation , renewal contracts and terminations.➢ Utilize appropriate clinical resources as needed.➢ Strong organizational skills , time management and follow through essential.➢ Pro-actively communicate with client employees as needed, ensuring a high-qualitycustomer experience. ➢ Complete employee employment verification and Unemploment paper work in timely manner.➢ Manage caseload efficiently, organize priorities, provide timely intervention, and maintain sensitivity to confidential records. Reed is➢ Provide support to Intake/Customer Service team as needed in our Call Center. Identifying and expediting priority issues Show less

Houston, Texas, United States

➢ Acts as a single-point-of-contact for the member. Explains member plan of benefits, member’s rights, and responsibilities in accordance with contracted arrangements, claim status information, benefit coverage, plan eligibility, dental, vision, pharmacy, HSA, provider details, care management, on-boarding, tool usage and available programs/resources.➢ Interacting with providers, clinicians, pharmacists, and many other professionals to provide total satisfaction and resolution to the… Show more ➢ Acts as a single-point-of-contact for the member. Explains member plan of benefits, member’s rights, and responsibilities in accordance with contracted arrangements, claim status information, benefit coverage, plan eligibility, dental, vision, pharmacy, HSA, provider details, care management, on-boarding, tool usage and available programs/resources.➢ Interacting with providers, clinicians, pharmacists, and many other professionals to provide total satisfaction and resolution to the member. ➢ Provides high-quality, customer-focused telephonic service using knowledge of procedures and systems to meet and/or exceed customer satisfaction.➢ Coordinates with clinicians to compile the member's Care Plan and conduct adherence follow-up➢ Ability to identify an individual and or/team performance weakness and strategize , develop and implement a method and plan for improvement.➢ Manage queue in line with SLAs➢ Handle escalated calls.➢ Assist and resolve patient Inquires/Requests in 24 hour period.➢ Knowledge of EOB’s , CPT and ICD- 10 codes ,HCFAs , UB04s , HCPCS , authorizations &referrals.➢ A full understanding of customer service , insurance follow- up process ( I.e Billing, Collections, Managed Care, Medicare , Medicaid, and Commercial Practices) Show less

Education record

Education record