Katherine Le: in Garden Grove, CA

Responsibilities and Duties: • Provide personalized customer service and assistance to assigned set of groups • Direct groups and brokers to carriers for claims and payment processing issues • Resolve eligibility and basic billing inquiries received from assigned set of groups • Document and coordinate all requested plan level changes from groups (i.e., plan changes, wait period, renewed changes) • Document and keep accurate and detailed notes of all correspondence with group and broker • Work with leadership and Senior CSR to escalate complex eligibility and billing issues to the carrier(s) for resolution • Promote value add products and marketing campaigns to groups and brokers as necessary • Build relationships with the main contacts for all large groups (50+ members) within their assigned set of groups to provide additional personalized service focused on group retention • Answer all incoming call and chat requests through the general hotline phone queue and chat software • Manages exceptions, determines eligibility holds, runs self-bills* and past due accounts

Responsibilities and Duties: • Meeting and exceeding department goals • Demonstrate ability to interact and communicate effectively with sales department, providers, and patients. • Processing orders and providing general details about product details to providers and patients • Responsibilities: • Provide exceptional client service to existing clients, offices, and clinics through outbound calls, being responsive to requests, identifying needs and offering solutions to program issues • Make sure that the information that I am providing is accurate and correct • Follow up with on requests and questions in a timely matter • Assist and implement company policies, procedures, and guidelines

Responsibilities and Duties: • Provide exceptional patient care • Scheduling Patients • Communicate insurance information to appropriate parties • Verify insurance benefits and eligibility • Obtain Prior Authorizations • Collecting Payments • Answering Phone • Assisting Physical Therapist with patient care

Achievements. • Providing excellent customer service and maintain a high-level service to brokers, groups, and members • Provide clear and explicit documentation • Achieve productivity goals and resolving issues in a timely and efficient manner Responsibilities and Duties: • Handles calls from customers to resolve, educate, follow-up and respond to questions regarding CaliforniaChoice plan administration and procedures • Educate brokers, groups, and employee's via telephone about Doctors, ID cards, RX problems, administrative procedures, dependent coverage, address changes, and benefit information • Follow-up calls from brokers regarding problems that their groups are groups and employees are experiencing • Responds to calls from providers about eligibility and benefits • Verify enrollments, benefits, and resolve claim issues • Expedite processing of enrollment and eligibility issues for employee's

Achievements: • Established and maintain a high level of patient and physicians satisfaction through daily interactions and exceeding daily productivity • Leading the authorizations team and troubleshooting, possible discrepancies between patients physicians and insurances Responsibilities and Duties: • Lead and manage authorization team effectively and efficiently train employees • Review authorization queue for applicable orders • Verify and comply with payer contractual authorization requirements • Submit authorization request timely and efficiently, ensuring proper documentation is included for review • Utilize website portal, and electronic options to submit authorization requests • Work with management to identify payer trends or potential issues • Demonstrate exceptional customer service skills in the performance of work assignments and duties • Scheduling and re-scheduling patients appointments with accordance with established protocols • Run daily logs for doctors and administrators 2-3 times a day • Verify patients eligibility through health plan and patients IPA • Maintain confidentiality of medical information • Alert staff, management and patients of any identified potential coverage issues

Responsibilities: • Provided prompt, accurate, and courteous customer service to clientele, in all manner communication and strict quality control guidelines. • Utilized various financial data management systems to provide in depth information to customers for retention. Processed various claims/transactions and identified opportunities to assist clientele where needed. • Maintains complete records on all accounts including, but not limited to, detailed documentation on all efforts, proof of timely filing, authorization hardcopies, correspondence from insurance for eligibility and benefits.

Achievements: • Experience with sales/marketing, claim processing and order management functions at many levels of the order process for member, providers, and health care networks. • Meeting and exceeding personal customer service and sales standards and those set by management, upholding standards of ethics and excellence above and beyond the standards of peers by providing a rewarding customer satisfaction experience. • Achieved productivity goals by utilizing telephone based approaches. Responsibilities and Duties: • Researched and provided courteous, accurate and timely responses to inquiries by health plan providers and members as related to referrals, authorization, and eligibility inquiries. • Billers are explaining balances, reviewing accounts for accurate billing, handle and resolve disputes from patients and provider, forward escalated issues as required to customer services supervisors. • Verified members eligibility, insurance, benefits and coverage. • Handled high volume for internal/external customer base.