SUZANNE HAWES
Newburyport
Summary
Dynamic and results-oriented patient service representative with a proven ability to deliver exceptional support to patients and providers. Adept at scheduling complex cases for top-tier practices. Extensive experience as a claims processor, showcasing a comprehensive understanding of claims policies and regulations, along with a successful track record in resolving escalated claims and addressing authorization and reimbursement inquiries. A seasoned entrepreneur and leader, recognized for cultivating strong relationships with customers and vendors while fostering a mission-driven culture that emphasizes creative problem-solving, effective communication, and teamwork. Committed to enhancing operational efficiency and patient satisfaction through dedicated service and innovative solutions.
Overview
28
28
years of professional experience
Work History
Patient Experience Representative II – Orthopedics & Sports Medicine
Boston Children's Hospital
12.2023 - Current
- Provide patient services to families and children with complex, typically urgent cases, in world-class practices that draw patients from all around New England and the U.S.
- Schedule new and follow-up appointments for over 50 physicians in orthopedics and sports medicine, including the urgent ortho clinic, with hundreds of patients a week in four locations
- Strengthened patient-provider relationships by serving as a liaison between healthcare professionals and patients, addressing any questions or concerns in an empathetic manner.
- Supported a positive patient experience through active listening, empathetic communication, and prompt issue resolution.
- Maintained patient confidentiality by adhering to HIPAA regulations and securely handling sensitive information.
- Evaluate incoming inquiries and coordinate with triage or the advanced practice clinician (APC) to escalate cases; Initiate calls for emergency services; Document calls in detail using CRM.
- Answer, screen, and route incoming calls, earning high scores on metrics including number of calls, time between calls, and customer service scores.
- Answer inquiries about hospital protocol, policies, and procedures; Respond to requests for information or assistance.
- Register patients; Record patient demographics and referral information; Verify insurance information, legal guardianship, and custody; Manage medical releases, respecting child services limitations on parental notification; Follow up with patients regarding non-clinical issues.
- Coordinate ancillary clinical and administrative services with other departments.
- Communicate with in-clinic staff; Message doctors and their teams, observing protocols for each provider and practice to facilitate management of complex patient issues.
Senior Claims Processor – Dental Operations
Blue Cross Blue Shield MA
07.2023 - 12.2023
- Approved or denied escalated insurance claims, from members and providers, based on complex enrollment, coding, or administrative requirements; Documented decisions to help providers re-submit claims for approval.
- Processed escalated billing issues, resolving worksheets from dental provider service reps requesting stop payment and/or reissue of checks; Created invoices to correct billing errors.
- Reported and addressed workflow and procedural issues in weekly meetings with the analysts, supervisor, and other claims processors; Answered hotline calls from member services reps.
Dental Provider Service Representative
Blue Cross Blue Shield MA
01.2022 - 07.2023
- Fielded a high volume of calls, resolving benefits, eligibility, and claims inquiries with providers; Promoted to add claims inquiries to benefit and eligibility questions related to deductibles, coverage, and patient history
- Researched reimbursement issues, claims processing errors, A/R inquiries, and missing or lost checks; Requested a reissue of checks or claims adjustments; Explained complex details of reimbursement, claims, dental policy, and CDT code guidelines; Described the steps to ensure accurate and timely processing
- Delivered superior service on a recorded line, with high scores for number and time of calls and resolutions
- Maintained productivity and quality standards at all times.
- Maintained comprehensive knowledge of company products and services, ensuring accurate information was relayed to customers at all times.
Cashier Full-Time/Part-Time
Whole Foods
10.2021 - 09.2022
- Delivered exceptional service to customers at a busy, upscale grocery store.
New Patient Coordinator – Breast Oncology
Dana-Farber Cancer Institute
07.2021 - 09.2021
- Reviewed pathology reports and diagnoses and spoke with new patients to schedule first appointments with a staff of 30 medical, surgical, and radiation oncologists; Collaborated with six new patient coordinators.
- Coordinated with hospitals and doctors’ offices to gather patient medical records and pathology results, and with internal teams who organized patient folders.
Founder
Joyofsocks.com
02.1998 - 06.2021
- Founded and led the internet’s first retail sock company; Grew annual revenues from $8K to $1M+; Pioneered the field of internet-only sales in a period of explosive change
- Oversaw all aspects of the business, from establishing strong relationships with specialty buyers to sales and marketing to managing inventory, advertising, and order fulfillment
- Hired, managed, trained, and scheduled part-time staff to run an efficient stocking, order fulfillment, and shipping operation; Maintained a loyal staff of 3 long-term part-timers, growing to 10 for the holidays
- Developed expertise in product knowledge, sizing, shipping times and methods, and order processing
- Created website content for all items; Managed email and social media marketing as well as e-commerce platforms.
- Ordered and stocked socks based on customer trends and projections; Oversaw all billing, AP/AR, collections, bookkeeping, and accounting, in collaboration with an accountant
- Grew operations from a North End apartment to retail stores in Rockport and Gloucester; Returned to internet-only sales from a warehouse in Newburyport with 1K SKUs
- Developed strong customer relationships through store interactions, emails, phone calls, and website questions; Turned around negative experiences with responses that exceed customer expectations.
- Established a successful business by identifying market needs and developing innovative solutions.
- Developed strong partnerships with other businesses to allow for collaboration and more significant opportunities for growth.
Education
B.S. - Marketing
Boston College
Skills
- Patient Services & Medical Scheduling
- Effective relationship management
- Healthcare Billing & Claims Processing
- Effective communication skills
- Knowledgeable in medical terminology
- Microsoft Word
- Microsoft Office
- Microsoft Teams
- Epic
- Client relationship management
- Innovative problem resolution
- Training & Mentoring
Accomplishments
- Patient Experience Representative – Boston Children’s Hospital: Schedule and coordinate complex cases for world-class orthopedics and sports medicine departments
- Senior Claims Processor – Dental Operations – Blue Cross Blue Shield MA: Resolve escalated claims; Authorize stop-payment/reissue of checks and AR requests
- Dental Provider Service Representative – Blue Cross Blue Shield MA: Resolved provider claim inquiries, problem solving reimbursement, benefits, and eligibility issues
- New Patient Coordinator – Dana Farber Cancer Institute: Reviewed patient records and scheduled first visit appointments, according to diagnosis, with radiation oncologists
- Joyofsocks.com: Founded and oversaw all aspects of operations for one of the internet’s first e-commerce sites; Grew annual sales from $8K to $1M with digital advertising; Orchestrated warehouse, order fulfillment, and shipping operations for up to 10 staff and 1K SKUs
Timeline
Patient Experience Representative II – Orthopedics & Sports Medicine
Boston Children's Hospital
12.2023 - Current
Senior Claims Processor – Dental Operations
Blue Cross Blue Shield MA
07.2023 - 12.2023
Dental Provider Service Representative
Blue Cross Blue Shield MA
01.2022 - 07.2023
Cashier Full-Time/Part-Time
Whole Foods
10.2021 - 09.2022
New Patient Coordinator – Breast Oncology
Dana-Farber Cancer Institute
07.2021 - 09.2021
Founder
Joyofsocks.com
02.1998 - 06.2021
B.S. - Marketing
Boston College
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