Customer Service Representative
Resume:
DEIDRA V. BECKER **** E TUFTS AVE. GREENWOOD VILLAGE, CO 80111 / 303-***-**** / acr0oc@r.postjobfree.com SUMMARY
Twenty-nine year career of increasing responsibility in administration, customer service and provider relations in multi-line health insurance industry.
TECHNICAL SKILLS & ABILITIES
CPT/ICD9 codes/HCPCS/UB92 Oracle Medical Terminology Iliad Microsoft Windows Rims Word/Excel/Outlook SharePoint
NICE DSC.2 ( Dental software)
EXPERIENCE
CLIENT SERVICE REPRESENTATIVE DELTA DENTAL OF COLORADO MAY 2009 – SEPTEMBER 2015
Troubleshoot entire claims process with hands-on analyzing and problem solving. Adjust payments, rush claims near to deadline, quote insurance, initiate coding corrections and obtain documentation. Verify claimant eligibility and benefits, advise providers with appeals policy and procedures and research and analyze and research and provide other relevant information. Assist providers with missing authorizations and pre- certifications to insure acceptance by system for correct payment of claim.
CLAIMS PROCESSOR AND CUSTOMER SERVICE REPRESENTATIVE CNIC HEALTH SOLUTIONS/ROCKY MOUNTAIN HEALTH PLANS NOVEMBER
2006 TO APRIL 2009
Third Party Administration of self-funded PPO’s and Claims Processing. Responsibilities include verification of claimant eligibility and benefits, managing interaction with providers regarding appeals policy, procedures, research and other relevant information.
PACIFICARE UNITED HEALTH CARE SYSTEMS MAY 1995 TO OCTOBER 2006
PROVIDER CUSTOMER SERVICE REPRESENTATIVE
Adjust payments, rush claims near to deadline, quote insurance, initiate coding corrections and obtain documentation. Verify claimant eligibility and benefits, advise providers with appeals policy and procedures and research and analyze and research and provide other relevant information. Assist providers with missing authorizations and pre-certifications to insure acceptance by system for correct payment of claim.
UNIT LEAD III
Overall responsibility for satisfactory resolution of medical provider claim problems. Supervise, train and develop team members. Schedule and assign duties and review and monitor work flow to meet deadlines. Review contractual, coordination of benefits and third party liability issues and take or advise appropriate action. Telephone auditing and monitoring. Facilitate provider enrollment and work closely with Medical Management, Accounting and other departments to ensure provider acceptance and satisfaction. Ensure accurate and timely closure to all provider issues and complaints.
CLAIMS PROCESSOR I
Process medical claims, including hospital and physician, durable medical equipment, nursing, foreign country and prescriptions. Coordinate benefits with Medicare and other carriers. Identify and resolve difficult issues regarding Claims and contract payments. Work closely with claimant, medical provider and Accounting to ensure prompt payment and to resolve differences.
EDUCATION
ATTENDED ARAPAHOE COMMUNITY COLLEGE
GEORGE WASHINGTON HIGH SCHOOL DENVER 1979 GRADUATE
REFERENCES
Alysia Neal Panko Delta Dental of Colorado 720-***-****
Vincent Chavez
Delta Dental of Colorado
Jennifer Sims
CNIC Health Solutions/Rocky Mountain Health Plans
Mary Hoang
PacifiCare United HealthCare Systems
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