MARY GRACE N.

Handled 30-60 inbound healthcare members' interactions daily via Genesis; verifying their benefits inquiries and assisting them in setting appointments with their doctors, making sure they are not out of compliance with their healthcare plan meeting HIPAA and CMS requirements. Resolved billing accounts, and service-related concerns with consistency to quality and compliance standards, assisting with newly established processes and ongoing training outside regular work hours to ensure current and trained staff were prepared to handle complex or high-risk cases appropriately, requiring escalation when necessary. Ensured accurate follow-up on cases for timely completion and provided resolutions and transportation options based on situations.

Handled 30-60 inbound healthcare members' interactions daily via Genysis; verifying their benefits inquiries and assisting them in setting appointments with their doctors, making sure they are compliant with healthcare regulations including HIPAA and SMA requirements. Resolved billing accounts, and service-related concerns with consistent adherence to quality and compliance standards; effectively stating policies, procedures and other call metrics. Maintained situation awareness interactions, through effective communication, empathy, patience, and active listening while reviewing case requests or appeals

Handled 30-60 inbound healthcare member interactions daily via Genesis, verifying their benefits inquiries and assisting them in setting appointments with their doctors, making sure they are on track of their health check thus meeting HIPAA and SSA requirements. Documented concerns while adhering to quality and compliance standards, especially with healthcare coverage and OTC orders.