Crystal Cain Email & Phone Number

Atlanta, GA, US

Greater Atlanta Area

• Reduced long-term healthcare costs by closing care gaps identified through HEDIS data
• Educated members on the benefits of preventive care and screenings
• Identified barriers to obtaining healthcare and provided resources to overcome them
• Updated members’ electronic health charts, demographic information, and program enrollment in compliance with all HIPAA regulations
• Aided members with scheduling appointments with their primary care physicians

Greater Atlanta Area

• Consistent top performer for call center metrics, provider surveys, and QA audits
• Provided detailed benefit and eligibility information to healthcare professionals
• Researched complex claims and expedited issues for processing and adjustments
• Directed healthcare providers to applicable reimbursement policies for accurate claims billing
• Routed documentation to appropriate departments for provider disputes and appeals
• Exercised an understanding of coding (CPT/ICD-10/modifiers) and CCI Edits

Greater Atlanta Area

• Entered accounts payable invoices, vendor credit memos, and reconciled statements
• Prepared and queued checks to be printed for vendors
• Processed return authorizations and replacement orders according to vendor procedures
• Managed dispute resolution process for BBB complaints and credit card charge backs
• Completed cancellations from customer service and issued refunds via Authorize.Net

Greater Atlanta Area

• Managed customer service inquiries via incoming calls and live chat
• Handled escalated calls from team members
• Verified stock on vendors’ FTP sites before order entry received the invoice
• Interacted with sales team to locate equivalent replacements for out of stock items
• Staff motivation and training to maintain a high level of customer service

Greater Atlanta Area

• Executed customer satisfaction surveys on behalf of automotive dealerships
• Entered daily survey results into an in-house application
• Consistently maintained high performance in volume of surveys
• Survey quality continually ranked in top 5% of peers
• Trained new employees on role requirements, policies, and procedures
• Monitored call recordings to locate surveys that were incorrectly flagged