Natasha Montgomery
Clayton
Summary
Experienced customer service professional with comprehensive understanding of health insurance, including claims, reimbursement, and eligibility requirements. Recognized as a leader in the field with a strong background in healthcare management and quality analysis. Served as a subject matter expert. Seventeen years of healthcare experience providing effective explanation and interpretation of insurance concepts to customers and employees. Known for dependability, attention to detail, and strong time management skills. Highly self-motivated talented professional considered a knowledgeable leader and dedicated problem solver. Bringing 17 years of valuable expertise to drive company objectives forward. Keen eye for detail and experience in coordinating projects, programs, and improvements make me well-equipped to contribute to the success of any team or organization.
Overview
17
17
years of professional experience
Work History
Temporary Program Manager
Mercalis
01.2024 - Current
- Managed and supervised administrative and daily program operations.
- Provide reimbursement metrics to clients and upper management.
- Consistently maintain reimbursement program service level agreement.
- Point in contact for all things related to reimbursement.
- Escalate issues that impact the programs performance.
- Established strong relationships with key stakeholders, ensuring support for program initiatives.
- Conducted one-on-one training to educate team members on program reporting.
- Identified program obstacles and communicated possible impacts to team.
- Utilized data-driven decision-making approaches to inform strategy development and optimize outcomes.
- Met with project stakeholders on regular basis to assess progress and make adjustments.
- Coached team members on professional development opportunities, contributing to improved overall performance.
- Optimized resource allocation, effectively balancing priorities and managing competing demands.
Program Supervisor
Mercalis
01.2018 - 01.2024
- Provide direction and leadership to a team of up to 10 employees on providing correct benefits to healthcare providers
- Review agent’s cases for accuracy before sending to healthcare providers
- Focus daily on improving productivity by researching pending patient cases and keeping track of the number of cases closed from each agent
- Provide suggestions on how to improve trends to leadership
- Coach team to meet the client’s stipulated service level agreement
- Collaborate with interdepartmental stakeholders to resolve escalations & program updates that affect other departments
- Consistently ensure SOP’s are followed
Reimbursement Specialist2
McKesson Specialty Health
01.2016 - 01.2018
- Proactively communicate with healthcare providers on their patient’s medication status post benefit verification to identify and prevent insurance barriers
- Contact specialty pharmacies monthly to confirm patients have received their monthly medication shipments
- Complete monthly adherence calls to identify any disruption in therapy
- Responsible for keeping track of when program forms are needed from assigned patients and healthcare providers
- Troubleshoot complicated patient cases that require strong attention to detail, to help avoid any interruption in patient’s therapy
Quality Analyst
Xerox - Anthem Blue Cross Blue Shield
01.2012 - 01.2015
- Listen to calls, provide quality feedback, and coach staff members on how to provide quality customer service, ensuring employees are performing up to the standards of the campaigns contract with WellPoint
- Deliver presentations on quality components during weekly business review, making WellPoint aware of the quality aspect of business
- Convey weekly updates to ensure employees are all on the same page with ongoing quality updates
- Administer floor support to agents to provide assistance with intensified phone calls, leading to decreased quality errors, and take escalated supervisor calls when necessary
- Lead and interacted with the client during bi-weekly call calibrations
- Received daily audits from the client to provide to the team
Subject Matter Expert
Xerox - Anthem Blue Cross Blue Shield
01.2008 - 01.2012
- Promoted from CSR to subject matter expert due to extensive knowledge of the Anthem Blue Cross and Blue Shield plans
- Supervised the call floor and addressed any questions or concerns with agents to ensure the correct information was being quoted
- Coached members of the staff on quality improvements to make sure agents provided excellent customer service, thereby meeting quality goals
Education
Bachelor of Business Administration - Cum Laude, Healthcare Management
American InterContinental University
Schaumburg, IL01.2014
Skills
- Microsoft Office: Excel, Word, PowerPoint
- SharePoint
- Salesforce
- CPR
- Detail-oriented
- Problem-solving
Community Service
Habitat for humanity of wake, 2015, 2016, Completed100+ hours of community services on construction site in wake county
Timeline
Temporary Program Manager
Mercalis
01.2024 - Current
Program Supervisor
Mercalis
01.2018 - 01.2024
Reimbursement Specialist2
McKesson Specialty Health
01.2016 - 01.2018
Quality Analyst
Xerox - Anthem Blue Cross Blue Shield
01.2012 - 01.2015
Subject Matter Expert
Xerox - Anthem Blue Cross Blue Shield
01.2008 - 01.2012
Bachelor of Business Administration - Cum Laude, Healthcare Management
American InterContinental University
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