Darlesha Holland
Phoenix,AZ
Summary
Member Service Specialist with experience in retail and customer service with dedication to providing quality customer satisfaction. Dedicated to providing superior support for patients in need of reliable information regarding insurance coverage, finance options and documentation requirements. Well-versed in scheduling and database management functions for streamlined communication and reduced correspondence backlogs. Excels at identifying client needs and concerns to improve engagement strategies and overall service.
Overview
12
12
years of professional experience
Work History
Intake Specialist/Patient Access Specialist
MCKESSON SPECIALTY PHARMACY
11.2014 - Current
- Reviews claims to make sure that payer specific billing requirements are met.
- Follows up on billing, determines and applies appropriate adjustment answer's.
- Resolved customer complaints using established follow-up procedures.
- Provided excellent customer service to patients and medical staff.
- Organized patient records and database to facilitate information storage and retrieval.
- Delivered support to medical staff in completion of patient paperwork.
- Knowledge of different insurances.
- Medicare Specialist
- Determine the appropriate level of service needed.
- Maintains a pleasant and respectful tone.
- Handle administration duties as needed.
- Transfer calls to the appropriate department.
- Navigating though computer systems.
- Developed and maintained databases to store customer information.
- Followed established procedures to enter and process data correctly.
Patient Access Representative
Central Abrazo Hospital
10.2022 - 09.2023
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Greeted and assisted patients with check-in procedures.
- Provided excellent customer service to patients and medical staff.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
Server
APPLEBEES
11.2017 - 07.2018
- Monitored patrons for alcohol intake to appropriate levels and took measures to curtail inappropriate behavior.
- Maintained order efficiency and accuracy through clear communication with kitchen staff, earning numerous recommendations from satisfied customers.
- Maintained clean and organized dining areas to uphold restaurant hygiene standards.
- Worked with POS system to place orders, manage bills, and handle complimentary items.
- Shared knowledge of menu items and flavors, enabling customers to make personal decisions based on taste and interest.
- Cultivated warm relationships with regular customers.
- Presented menus to patrons promptly after seating and answered questions about menu items, making recommendations upon request.
- Followed health and safety protocols crucial for maintaining safe and sanitary environments for customers and staff.
- Maintained thorough menu knowledge to sufficiently answer questions regarding menu item sourcing, ingredients and cooking methods.
- Explained menu items and suggested appropriate options for food allergy concerns.
- Displayed enthusiasm and promoted excellent service to customers, successfully increasing referrals, and walk-in business.
Dispatcher
LogistiCare Solutions LLC.
03.2014 - 03.2015
- Managed high-stress situations calmly and effectively, ensuring timely assistance to those in need.
- Communicated with drivers and personnel to coordinate timely delivery of goods and materials.
- Directed dispatching, routing, and tracking of [Number] fleet vehicles.
- Collaborated with fellow dispatchers to maintain a seamless workflow during shift changes.
- Maintained updated and detailed records of calls in physical and electronic database.
- Consistently met performance metrics for call handling, contributing to the overall success of the department.
- Reduced errors in dispatch logs by implementing a thorough double-check system for all entries.
- Facilitated smooth transitions between shifts by properly documenting unresolved calls and ongoing incidents.
- Managed conflict resolutions with customers, drivers and other personnel to encourage professional relationships and promote respect.
MEMBER SERVICES / PHARMACY BENEFIT MANAGER
Catamaran
10.2013 - 02.2014
- Maintain a clear understanding of clients policies, procedures, and individual needs.
- Assist pharmacies and/or clients with resolving a variety of daily processing obstacles.- Problems solving and the ability to communicate is essential.
- Communicate effectively and clearly with members regarding questions about pharmacy plan coverage, co-payment, deductible and other aspects of their program.
- Collect accurate information and documents unresolved issues.
- Works with teammates, account manager and other resources to solve those issues.
- Fulfill any client request that are faxed directly to member services.
- Modifications to records within the RXCLAIM system, and call tracking
- Documents each call received.
- File and maintain paper records in an organized manner.
- Perform daily functions as well as other projects and responsibilities.
Customer Service Cashier
FRYS FOOD STORE
04.2012 - 05.2013
- I was taught to demonstrate effective and appropriate communication with customers of various backgrounds.
- Processed refunds and exchanges in accordance with company policy.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Worked with floor team and managers to meet wide range of customer needs.
- Monitored self-checkout systems and provided help in resolving complex problems.
- Operated cash register to record transactions accurately and efficiently.
- Counted money in drawers at beginning and end of each shift.
- Resolved customer complaints and maintained clean and tidy checkout area.
- Maintained current knowledge of store promotions and highlighted sales to customers.
Education
Glendale Community College
Phoenix College
Winslow High School
2010
Preschool
Northern Pioneer College
2010
Skills
- Collections Processing
- Handling Complaints
- Individualized Care Plans
- Customer Service Standards
- Ability to work effectively under time and pressure for long and extended hours
- Good memory and eye for details
- A strong passion to ensure customer and client satisfaction
- Strong communication skill
- Data Entry
- Critical Thinking Skills
- Scheduling appointments
Timeline
Patient Access Representative
Central Abrazo Hospital
10.2022 - 09.2023
Server
APPLEBEES
11.2017 - 07.2018
Intake Specialist/Patient Access Specialist
MCKESSON SPECIALTY PHARMACY
11.2014 - Current
Dispatcher
LogistiCare Solutions LLC.
03.2014 - 03.2015
MEMBER SERVICES / PHARMACY BENEFIT MANAGER
Catamaran
10.2013 - 02.2014
Customer Service Cashier
FRYS FOOD STORE
04.2012 - 05.2013
Glendale Community College
Phoenix College
Winslow High School
Preschool
Northern Pioneer College
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