Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Monique Rowe

Prince George

Summary

Dedicated professional with over five years of experience in healthcare and insurance customer service, demonstrating expertise in navigating the EPIC System. Proven track record in providing exceptional patient support, efficient claims processing, and managing high-speed Internet communications highlights a commitment to excellence. Eager to leverage skills and knowledge in a Patient Support Center Representative role to enhance patient experiences and streamline service delivery. Strong interpersonal abilities combined with a detail-oriented approach ensure effective communication and resolution of patient inquiries.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Claims Specialist

CVS
05.2023 - Current
  • Review and process medical claims to ensure accuracy, completeness, and compliance with insurance policies and regulatory standards.
  • Conduct eligibility and benefits verification for insurance coverage and pre-authorization requirements, ensuring accurate medical coding for procedures and diagnoses.
  • Investigate claim discrepancies and denials, collaborate with stakeholders to resolve issues, and manage appeals for rejected claims, maintaining detailed records for audit purposes.

Patient Access Registrar

Ensemble
07.2024 - 08.2025
  • Managed patient registration process, ensuring accuracy and compliance with healthcare regulations.
  • Coordinated insurance verification and eligibility checks to enhance patient experience and streamline admissions.
  • Implemented process improvements that reduced wait times for patients during peak hours.
  • Oversaw data entry into electronic health record systems, maintaining confidentiality and integrity of patient information.
  • Improved patient satisfaction by efficiently registering patients and verifying insurance information.
  • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
  • Determined patient financial needs and referred eligible patients to proper county, state, or federal agencies to obtain financial assistance.

Front Office Assistant

United Healthcare
05.2022 - 05.2023
  • Managed front desk operations, adeptly handling patient scheduling, fielding inquiries via phone and email, and facilitating a welcoming environment.
  • Verified insurance details and secured authorizations for medical procedures, contributing to precise billing processes and effective reimbursement management.
  • Maintained and updated electronic medical records (EMR), ensuring accuracy and confidentiality, while also assisting in account reconciliation and invoice generation.
  • Escalate items to other areas outside of department as needed
  • Work with payors and providers to ensure compliance with enrollment process
  • Initiate contact with payors and practices via telephone or electronic methods with respect to provider enrollment and billing errors, utilizing proper customer service protocol
  • Update and maintain data in appropriate Provider Enrollment systems while ensuring accuracy and data integrity
  • Review correspondence received and perform appropriate action to resolve
  • Appropriately resolve or escalate payor application denials
  • Managed front desk operations, ensuring efficient patient check-in and appointment scheduling.

Membership Representative

Anthem Inc
05.2021 - 12.2021
  • Assisted Medicare beneficiaries by clarifying plan coverage, benefits, and enrollment options, ensuring members received precise and comprehensive information.
  • Guided members through the enrollment process, aiding in eligibility verification, plan comparison, and form completion to facilitate their understanding and selection of appropriate Medicare options.
  • Resolved member issues with empathy and efficiency, while meticulously documenting interactions in CRM systems to uphold high standards of record accuracy and support continuous service enhancement.

Customer Service Representative

Kaiser Permanente
11.2018 - 08.2020
  • Addressed customer inquiries regarding insurance coverage, claims, and billing, providing clear information and guidance to policyholders.
  • Managed policy modifications, renewals, and compliance adherence, streamlining processes for customer satisfaction.
  • Resolved a range of customer issues in collaboration with cross-functional teams, ensuring accurate record-keeping of interactions and transactions.

Loss Draft Representative

Assurant (Chase Bank)
10.2017 - 11.2018
  • Reviewed and assessed property damage and loss claims to determine insurance coverage eligibility, ensuring meticulous compliance with mortgage requirements.
  • Facilitated effective communication between insurance companies, homeowners, and contractors to obtain essential documentation for expedient claims processing.
  • Addressed and resolved client inquiries regarding claim status and payment procedures, delivering high-quality customer service and maintaining accuracy in documentation handling.

Education

High School Diploma -

American Worldwide Academy
05.2014

Skills

  • Patient Registration
  • Insurance Verification
  • Customer Support
  • Communication
  • Problem-Solving
  • Conflict Management
  • Teamwork
  • Time Management
  • Listening
  • Verbal communication
  • Customer service
  • Critical thinking
  • Organizing and prioritizing work
  • Attention to detail
  • Multitasking Abilities
  • Problem-solving
  • Policy interpretation

Certification

CRCR revenue cycle

Timeline

Patient Access Registrar

Ensemble
07.2024 - 08.2025

Claims Specialist

CVS
05.2023 - Current

Front Office Assistant

United Healthcare
05.2022 - 05.2023

Membership Representative

Anthem Inc
05.2021 - 12.2021

Customer Service Representative

Kaiser Permanente
11.2018 - 08.2020

Loss Draft Representative

Assurant (Chase Bank)
10.2017 - 11.2018

High School Diploma -

American Worldwide Academy

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Monique Rowe