Palethia Sanders
Raleigh
Summary
With over 11 years in Quality Assurance experience in a Contact Center Setting and 20 years in Customer Service, I've honed my skills in HIPAA compliance and effective communication. My background includes significant achievements in improving customer and patient access and mentoring new staff, showcasing my ability to multitask and solve problems efficiently.
Overview
21
21
years of professional experience
Work History
Patient Access Coordinator/Case Manager
McKesson Pharmaceutical Company
08.2021 - Current
- Communicating with an assigned region of patients', Healthcare Providers, and the patients' insurance plans to get the patients' medication Kesimpta covered by initiating outbound call and accepting inbound calls using the remote phone system Five9 working in a Work from Home environment.
- Conducting Benefits Investigations with patient’s insurance plan to determine coverage for the medication Kesimpta.
- Communicating with patient’s Healthcare Provider about submitting a Prior Authorization to patient's ins plan and checking status of Prior Authorization.
- Educating patient on the Alongside Kesimpta Program and managing each patients' case using the CoverMyMeds and Hubble Systems.
- Educating patients on additional financial options when Kesimpta isn’t covered.
- Electronically Triaging Prescription to patients' pharmacy.
- Troubleshooting any issue with patients' pharmacy reported by the patient or Healthcare provider.
- Reporting any sides effects to the drug manufacture Novartis Pharmaceuticals that the patient any experience while taking Kesimpta.
- Communicating with the region's Field Reimbursement Manager on each patients' case by email, phone, and conducting weekly meeting via Microsoft Teams.
- Mentoring new Patient Access Coordinator by offering hands-on training, answering questions, and providing ongoing support to accelerate their learning curve.
- Being abreast on all hot topics and trends with in the Alongside Kesimpta Department and communicating any issue trending issue to my supervisor.
- Maintained strict adherence to HIPAA regulations while managing confidential patient information throughout various stages of care.
- Contributed to a positive work environment by providing support and assistance to colleagues during peak periods or staff shortages.
Quality Assurance Analyst/Broker
Aerotek/Maximus
01.2021 - 06.2021
- Conducting performance evaluations for NC Medicaid Enrollment Brokers to identify and categorize staff members as target achievers and under achievers. Guide under achievers on ways to improve work performance.
- Speaking with Brokers one on one through Zoom video and educating them on technical aspects, communication skills, knowledge of product, problem-solving abilities, etc.
- Assisting with answering inbound calls in a Work from Home remote call center setting when necessary and enrolling eligible Medicaid Recipients in Medicaid Managed Care Plans, educating Medicaid.
- Educating eligible Medicaid Recipients on the different Managed Care plans and advising non-eligible Medicaid Recipients on why they are not eligible for Managed Care plans.
- Maintaining a history of each Broker’s work performance.
- Broker's Performance Evaluation and inbound calls were completed in the Genesis Phone System.
Revenue Cycle Representative
Rex Hospital Healthcare Systems
09.2018 - 10.2020
- Answering high volume phone calls in a call center setting.
- Trained in Hospital and Professional Medical Billing.
- Assisting patients and medical insurance representatives with patient’s hospital and professional billing question and concerns.
- Reviewing and educating patients on their explanation of benefits.
- Processed medical payments and set up payment plans for patients.
- Updating patients' Demographic and Medical Insurance information.
- Being abreast on all hot topics and trends with in the Rex medical billing department.
- Communicating any issue trending issue to my supervisor.
- EPIC Systems trained.
- Maintained strict adherence to HIPAA regulations while managing confidential patient information throughout various stages of care.
- Transitioned to remote Work from Home setting to adhere to COVID policies.
Quality Assurance Analyst/Customer Service Representative
Conduent/Humana Mail-Order Pharmacy and Humana Ins
08.2008 - 09.2018
- Conducting performance evaluation of employees to identify and categorize staff members as target achievers and under achievers. Guide under achievers on ways to improve work performance.
- Monitor the daily functions of the call center and ensure smooth operation of all activities. Take initiative to resolve issues, if any.
- Speaking with new agents one on one or in group setting and educated them on technical aspects, communication skills, knowledge of product, problem-solving abilities, etc.
- Speaking with supervisors and informing them on the most up to date information and their agents work performance by setting up group huddles and meetings.
- Working with client to make sure we are 100% calibrated on agent’s evaluations.
- Maintain a history of each agent’s work performance.
- Multitask and use various database.
- Filling prescription for patients and informing them of refills remaining.
- Keeping patients up to date on their billing and account information.
- Evaluations were completed in the Verint System.
Customer Service Representative/Customer Service Help Desk Representative
Affiliated Computer Services-Humana Insurance
01.2006 - 07.2008
- Answering high volume phone calls in a call center setting.
- Educating Humana members about their Medicare Medical and Prescription drug insurance.
- Trained in Humana Insurance Medicare Pharmacy, Medical claims and benefit, and billing.
- Updating member’s billing and personal information.
- Processed payments for member’s premium to keep their account current.
- Advising member’s pharmacist of any processing issue with member’s prescription claims using the Argus Pharmacy Claim system.
- Assisting other Customer Care Representative with question handling their escalated calls when necessary and finding satisfactory resolutions for both customers and the company alike.
- Identifying the root cause of the issue by listening attentively to the member or Customer Care Representative and asking probing questions in order to take the appropriate to correct the issue.
- Multi-tasking and using various database at once.
- · Maintained strict adherence to HIPAA regulations while managing confidential member information.
Customer Service Representative/Insurance Specialist
Triangle Rent A Car
04.2004 - 02.2006
- Answering high volume calls in a call center setting
- Quoting price rates for rental vehicles
- Qualifying and reserving rental vehicle for customers
- Verifying customer’s automobile insurance coverage
- Communicating with insurance companies to making sure all claims were accurate and valid
- Entering customers’ personal information into computer database and using all precaution to protect private information.
- Contacting automobile repair shops to check the status of repairs for customer’s personal vehicle
- Extending rental contracts by authorizing customers credit or debit or notifying insurance company
Education
High School Diploma -
William G Enole High School
Raleigh, NC06-2003
Skills
- 20 years of customer service skills
- 20 Contact Center experience
- 11 years Call Contact Quality Assurance Analyst Experience
- 5 Year Work from Home experience
- Experience in handling confidential paperwork
- Strong verbal, written, and listening skills
- Good customer-relations background
- Adept at multitasking
- Able to negotiate and problem solve quickly, accurately, and efficiently
- Good filing and organizational skills
- HIPAA compliance
Timeline
Patient Access Coordinator/Case Manager
McKesson Pharmaceutical Company
08.2021 - Current
Quality Assurance Analyst/Broker
Aerotek/Maximus
01.2021 - 06.2021
Revenue Cycle Representative
Rex Hospital Healthcare Systems
09.2018 - 10.2020
Quality Assurance Analyst/Customer Service Representative
Conduent/Humana Mail-Order Pharmacy and Humana Ins
08.2008 - 09.2018
Customer Service Representative/Customer Service Help Desk Representative
Affiliated Computer Services-Humana Insurance
01.2006 - 07.2008
Customer Service Representative/Insurance Specialist
Triangle Rent A Car
04.2004 - 02.2006
High School Diploma -
William G Enole High School
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