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Customer Service Representative

Location:
Eastlake, OH
Posted:
April 12, 2014

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Resume:

Anne E. Candela

*** ******** *****, ******** **** 44095

440-***-****

Customer Service * Data Entry * Microsoft Word/Excel * Medical Billing * Physician Billing *

Insurance Follow Up * Registration * Appointments * Coordination of Benefits * Catastrophic First

Notice of Loss Representative

Skills and Training

Currently being trained on Catastrophic Weather Related Customer Service relations.

Over 20 years administrative experience – in bound calls, out bound calls, superior data entry skills, 10-

key by touch, proficient typist, filing and excellent attention to detail

Over 15 years in the healthcare industry

Proficient in both Hospital Billing and Professional Billing

Extensive Customer Service Skills

Knowledge and Use of the Epic system, HBO system, SMS system and Meditech. Electronic Medical

Records.

Knowledge and Use of Navinet, Mits and Availity as well as several other internet sites

Professional Experience

April 2014 – Current, Catastrophic Management Solutions: Customer Service Representative

In training to assist All State Insurance policy holders when catastrophic weather related issues arise. The

customer service representative is the first person a policy holder reaches when a catastrophe has changed

their life. As a customer service representative the responsibility includes beginning the claim process

which includes verification of coverage, policy type, in some cases advising of benefit coverage,

assigning a claims adjuster and setting up appointments as needed depending on catastrophic losses. This

is a contingency position – the work hours are available when or if a catastrophic event occurs.

August 2013 – February 2014, Independent Physician Solutions: Patient Account Representative

Entered hand written professional (doctor) billing services and diagnosis codes into the billing system

including creating a patient demographic for new patients. Followed up on submitted claims including

but not limited to working rejected claims correcting any errors in an effort to obtain prompt payment

from the insurance carrier.

June 2013 – July 2013, Avery Dennison, through Alijon Professional Services: Data Entry

Specialist

This was temporary position to assist the forewoman in creating a complex spread sheet that would hold

the formulas(s) for routine and special order (jobs). This was an alpha numeric series of specs that were

entered in to excel and to be used to create a “recipe” for a specific job. Once all this information was

entered into the computer system the machine operators merely had to enter the job code and all the specs

for that specific job was populated on to the computer system that ran the machine. I had to be very

detailed with this as anything that was entered wrong would ruin the recipe and ruin the job.

Caregiver for my Mom

July 2011 – February 2013, When it became clear that my mom could no longer be home alone (she was

living with me) I resigned from the Cleveland Clinic to care for her as a permanent caregiver. She had

dementia and at the time was 91 years old.

The Cleveland Clinic

Health Unit Coordinator - (2009-2011), Account Rep I - (2005-2009), Hospital Billing - (1999-

2005), Customer Service Representative - (1998-1999)

Health Unit Coordinator: Worked on the cardiac care floor at night assisting the nurses and doctors with

administrative duties such as putting together patient charts, answering phones, arranging for transfer of

patients to ICU, arranging the transfer of a patient from a sometimes out of state facility to the Cleveland

Clinic and answering patient call lights.

Account Rep I/Neurological Institute: Responsible for the Denial Data Base resolving all claims that

were submitted and returned from the insurance carrier for various reasons. Updated Patient Registration,

precertification and authorization of Mental Health Services. Assisting the coding and reimbursement

specialist as needed. Maintained the VIP patient appointments, billing and copayments using discretion

as these patients were public figures, sport’s figures or high profile business men/women.

Hospital Billing: Reviewed all claims that were held for editing purposes. Reviewed and had claims

corrected so that a clean claim would be submitted to the patient’s insurance carrier. Followed up with

insurance carriers on unpaid claims, provided documentation when required. Contacted patients with

regards to insurance information including but not limited to Workers Compensation information. Placed

calls to both insurance carriers and patient’s as needed. Excellent understanding of coordination of

benefits specifically Medicare Secondary Payer.

Customer Service: Received inbound calls from patients, insurance companies and employers. This

resulted in an excellent knowledge of the hospital and professional side of the clinic’s billing system.

Resolved all patient issues and initiated patient refunds as well as insurance refunds due to over

payments.

References upon Request



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