Rhonda Wright Email & Phone Number

(Remote) New York

.• Conducted weekly one on one coaching’s with 10 direct reports to track KPI's while identifying best practices and implementing progressive corrective actions that increased SLA's by 25%.• Participated in company sponsored global trainings such as Developing Leaders, Conflict and Resolutions , and Know Your CustomerState Regulations & Staying In Compliance.• Coordinated weekly and monthly unit meetings and one on one coaching's, initiated on behalf of senior management.• Spearheaded the Focus Group to streamline work instructions script to reduce AHT and transfer transaction processing time by 15%.• Conducted research and implementation of a new auto answer to improve bounced call rates efficiency by 90% and enhancing incoming calls accuracy.• Assist in training 10 direct reports and new hires on Company regulated processes and other workforce systems.• Consult with management on weekly basis to review the impact of SLA reports and necessary corrections to increase KPI's.

Retrieved inbound calls from members. Assisted with claim inquiries, member status, prior authorization for in-network providers. Processed and applied member premium payments. Follow Compliance HIPAA guidelines. Escalated calls to in-network participating in the pharmacy for prior approval for specific medication. Escalated provider inquiries for outstanding claims.Monthly Mandatory meetings with Management discussion of product updates and State Regulations and newly implemented policy processes.

Staten Island Ny

Resolve customer issues via one call resolution guidelines and/or escalated process. (i.e. communicating with enrollment Dept, Intake Dept, Grievances and Appeals Dept, Care Management Dept).Complete assigned tasks and projects based on set priorities and deadlines(ie. outreach to new enrolled medicare plan members)Maintain strong knowledge of assigned products/markets and the applicable state and federal regulations.( ie. Medicare, Medicaid, Advantage Plans, HMO, PPO)Assisted members with Insurance benefits inquiries such as copay, out of pocket expenses(deductible), covered services, prescription tier level, transportation, etc.Reviewed calls and processes to ensure that they aligned with companies current trends.Monitored, motivated, and coached claims team staff to improve quality and performance by singly member service skills. Enhanced team performance through coaching, feedback, and effective communication, increasing team efficacy rate by 10% with higher job satisfaction reported amongst staff.Communicated daily with enrollment intake department, Grievances and Appeals, and Care Manager Plan team.Assist providers with issues of credentialing with one call resolution. Escalated cases to credentialing department to expedite licensure and certifications inquiry status.Collaborate with credentialing department to update new providers with concerns to process claims Maintained strong knowledge of assigned products/markets and the applicable State and Federal regulations.Built a rapport with regular consumers and maintained effective professional relationships with employees and vendors.

Brooklyn, New York

Analyzed department reimbursement reports for insurance errors before submitting to Claims Analyst. Reviewed electronic claims and followed up on delinquent accounts.Registered new clients, schedule and arrange appointments ,obtained electronic referrals for scheduled patient visits. Examined diagnosis codes for accurate claim submissions specific and appropriate to services rendered. Coordinated surgery patients with the Surgery Coordinator Department to schedule appointments and care.

Brooklyn, New York

Completed Internship with this great company. Verified patients’ service eligibility for third party facilities.Contacted various insurance companies regarding claims status. Entered billing for Physical therapy group, and Primary care physician

Brooklyn,Ny

Worked with admissions department. Assist admission director with standard office work which include filing, shredding, organizing etc.

Brooklyn, New York

Managed the daily operations of medical records, medical assistants, and laboratory staff. Analyzed patient satisfaction surveys; identified trends and patterns of patients.Prepared and submitted daily reports; established financial and collection reports. Facilitated and participated in Annual Health Fair projects and community events.Monitored and submitted employees quarterly progress review and select top performers.

Associate'S Degree, Health Office Administration, 3.91

Activities and Societies: Alpha Theta Kappa Honor Society Attended and Completed the Interview Workshop in the Career Development.

Associate'S Degree Aos, Healthcare Office Administration, 3.91

Activities and Societies: Alpha Theta Kappa Honor Society