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Danielle A. potts

Customer Service Representative

Work History

June 6, 2017Present

Patient Services Advocate

Southwest Medical Associates - United Health Group - Las Vegas, Nevada
  • Achieved performance evaluations for call handling ability and quality of services provided to patients in a fast paced, high volume call center.
  • Assisted patients with all aspects of insurance billing resolution or payments and documented any information or conversations in the computer regarding the patient's accounts.
  • Understand the importance of dealing with confidential information.
  • Resolved problems or escalated to managers as needed -able to diffuse intense situations and frustrated callers.
  • Provided information regarding patient accounts to authorized callers while complying with HIPPA guidelines and regulations.
  • Verified and updated patient demographic information and insurance information.
  • Scheduled and rescheduled appointments in person and via phone.
  • Scheduled appointments and referrals from other medical offices.
  • Monitored work queues to ensure information was complete in EPIC HIS system.
  • Assisted in the referral process such as faxing referrals and scanning related documents.
  • Completed daily reminder calls to patients regarding upcoming appointments.
  • Interacts with members of the professional staff and ancillary personnel while acting as liaison between physicians, nurses and patients. 
  • Identifies whether patient needs authorization or referral.

Medical Systems 

  • AYS-At Your Service,
  • Genesis soft phone system
  • TouchWorks
  •  Centricity
  • IDX
  • Microsoft - Excel, Power Point and Word.
September 9,2016June 6, 2017

Pharmacy Prior Authorization Specialist for Workers Compensation Specialist

Optum Rx  - United Health Group - Las Vegas, Nevada
  • Processing Workers Compensation Claims.
  • Manage inbound calls from insurance adjusters.
  • Manage inbound calls from major pharmacy's.
  • Authorizing medications, restricting medications, and doctors.
  • Processing prior authorizations to major insurance companies for decisions on medications.
  • Identifying medications and strengths, emailing various teams and insurance companies.
  • Evaluate and approve / deny adjuster requests to authorize medications. 
  •  Maintain productive working relationships and communications with all claim service providers and insurers on all aspects.
  • Ensure delivery of quality services and nurture positive employee/client relationships
  • Patient Benefits Verification
  • Patient Account/Claim Creation
  • Receive and verify requests for prior authorizations and ensure that they are administered properly
  • Verify Medications
  • Medication Authorization Processing
December 2013September 2016

Reservation Specialist

MGM Grand Resorts International  - Las Vegas, Nevada
  • Answered incoming calls and assisted with reservations, confirmations, room requests, and questions.
  • Familiarity with all day-to-day routine hotel practices, including billing transactions and credit and debit card procedures.
  • Assisted guest departures providing accurate statements and collecting all payments due, while assuring guest satisfaction.
  • Contacted maintenance and housekeeping resolving any guest issues.
  • Maintained knowledge of current resort events and upon request arranged tours, transportation, restaurant reservations, and activities for guests.
  • Processing account refunds. Referring Guest to Rewards (M-life) Program.
  • Maintains knowledge of all MGM Grand Resort Property Rooms, Shows, and Dining.
  • Provide "world class" customer service to potential and established guests.
  • Provided show times and dates for shows.
  • Received calls for reservations for national chain of hotels.
  • Resolved customer concerns with reservations or billing issues.
  • Created membership accounts.
  • Utilized excellent communication skills and problem solving skills to manage customer relationships.
  • Took initiative and utilized good judgment in decision making within company guidelines.
  • Organizational skills with attention to detail and able to handle multiple tasks
  • Process client request such as cancellations and changes to their reservations.
February 2009July 2013

Patient Care Coordinator

Advance Chiropractic Services  - Indianapolis Indiana
  • Scheduled patients.
  • Established new patients and created electronic files for them.
  • Answered multi-line phones.
  • Collected co-pays, co-insurance and all other balances.
  • Faxed, scanned, and recorded all necessary medical documents.
  • Assisted physical therapists as needed and maintained cleanliness of facility.
  • Communicated with other doctor offices, imaging offices, and all other organizations as needed.
  • Managed the patient schedule, worked with front office and back office staff to ensure organization.
  • Organized and maintained patient charting process, prioritized and reviewed charts for completeness.
  • Verified insurance for treatments, collected payment from patients, and reconciled daily cash reports.
  • Consult with patients regarding treatment plan and determine insurance calculations and financial options.
  • Developed and maintained relationships with the patient's insurance carriers.
  • Provided training and assistance to new Patient Care Coordinators.
  • Followed and properly executed company policies and procedures.

Education

19941999

High School Diploma

Benton Harbor High School

General Studies Diploma

20122014

Hospitality Administration 

Ivy Tech Community College

Knowledge Of Hospitality Field 

Skills

Customer Service Skills 
  • Advance Customer Service skills,
  • Inbound and Outbound Calls
  • Hard Phone and Soft phone
  • High Volume Call Center
  • Pharmacy Eligibility  
  • Member Benefits Eligibility 
  • Benefits Specialist
  • Seven Years of Customer Service/Call Center Experience
  • Payments and Services Support
  • Ability to multi-task, manage details and organize efficiently and effectively
  • Ability to listen compassionately demonstrating effective problem-solving and critical-thinking techniques.
  • Ability to prioritize,
  • Excellent typing and 10 key
  • Excellent written and verbal communications,
  • Able to communicate effectively with all levels of Internal & external customers
  • Ability to use relevant computer hardware and software, telephone, copier, fax machine and other standard medical office equipment
  • Strong team orientation
  • Ability to read, interpret, and apply policies and procedures
Leadership Skills - United Health Group/Optum Rx
  • Mentoring and Training a team of 5
  • Advising a team of 5
  • Assisting with daily work task
  • Answering various questions about my day to day process of duties
  • Coaching a team of 5
  • Listening to calls and advising 

Certifications

Jun 2013Present

Food & Beverage Supervision 

Ivy Tech Community College
I've passed all Academics to become certified to be a Food and Beverage Supervisor.
Jan 2013Present

Hospitality Human Resource Management and Supervision 

Ivy Tech Community College 
I've passed all Academics to become certified to be a Human Resource Manager in the Hospitality Field.  
02/2017Present

Leadership

Untied Health Group/Optum Rx

Leadership Resignation - For Training & Mentoring a Team of 5