D. Antoinette Phelps

**** ****** **** #***,*********, FL 33534

Cell 321-557-5954Phone 813-***-**** OR 813-***-****

acr13l@r.postjobfree.com

Summary of Qualifications

• Retention Collections

• Account Receivable

• Medical Billing

• Collections Accounts

• Medical Management

• Medical Mysis Billing Systems

• MS Office Suites

• MS Windows

• Customer Service Specialist

• Medical Terminology

• Availity

• Medical Administrative Assistant

• AS400 Med Billing System

• CPT/ICD9

• Medicaid/Medicare Billing

• Delotte Billing System

• Cigna

• VSIP Medicaid/Medicare Banking

• Fl-Blue

• CSR/Financial CSR

• UAT/AML/Fraud experience

• B2B Sales Representative

• Call Center Specialist

•

Professional Experience

• Collect and Process Payments make payment arrangements making 80-200 calls per day

• Handling service issues Activating/Closing Accounts MS Word

• Excel PowerPoint Medical Billing / Coding

• Medical Insurance/ MS Outlook/ MS Windows/ MS Outlook

• Sales B2B Sales Account Rep Experience.

Work Experience

Health Integrated -07/2012-05/2013

Client Service Rep/UM REP

• Responsible and accountable for providing customer service and support to all clients, primarily by answering and responding to all inbound calls from providers, members, and clients

• These call types include locating members; verifying membership eligibility

• Locating providers and processing referral notifications.

• Administrative tasks generated from the call are performed with this position

• Responsible and accountable for quality service delivery

• Understanding and maintenance of applicable policies and procedures

• Maintenance of minimum performance metrics both individually and at the team level

• Demonstrated ability to type 50 words per minute with 90% accuracy while engaged in a telephone conversation

• Demonstrated proficiencies with basic computer skills to include how to navigate, accessing of various programs and use of Microsoft Outlook email

• Must be an effective communicator, both written and verbally - able to clearly articulate information to both providers and members

• Demonstrated success in a call center environment to include multi-tasking as well as the ability to focus singularly on the task at hand

Well Care- Member Engagement Specialist Representative

• Conducts outreach calls to Member that may be potential Case/ Disease Management candidates. Performs low level assessment to ensure the potential Member qualifies for a program

• Answer inbound calls in reference to potential Case/Disease Management Candidate

• Answers routine telephone calls and direct to appropriate person/department

• Assists Members to access needed departments

• Under Manager/Supervisors management, receives, researches, reviews and streamlines processes and tracks all incoming Case/ Disease Management referrals

• Documents all actions taken regarding referral and contact related to member

• Conducts outbound calls to members as appropriate for the needs of the department, LOB, and markets

• Collects and verifies information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation

• Provides customer service functions and coordinates member needs with the appropriate level of care

• Applies policies and procedures, regulatory requirements and accreditation standards to all activities

• Performs data entry of authorizations, contacts, in the EMMA system and schedules nursing assessments in Outlook

• Special projects including fulfillment of educational material, data entry, research, records retrieval, etc

• Receives and sends incoming and outgoing faxes

• Receives and distributes incoming and outgoing mail

• Assists in preparing and submitting projects, reports or assignments as needed to meet organizational initiatives and/or objectives

CareCentrix- 11/11-06/12

Medical Claims Rep

• Reviews specific billing, pricing and coverage rules of a payer during contract negotiations to ensure contracts can be effectively serviced through the billing system

• Ensures all information received is accurate and complete to mitigate risk of lost revenue as a result of the billing process

• Works with management to define business rules, cost savings for system enhancements, and break fix issues Responsible for entering system enhancements into RFS reporting module

• Generates weekly RFS reports for management and gives updates in NBC management meetings

• Reviews business requirements documented by BSG, assigns UAT teams, coordinates UAT testing, communicates business sign off to BSG, pass/fails production regression testing, and communicates business sign off to BSG

• Creates system gap analysis reports, identifies issues, and proposes solutions

• Works with Internal Audit to ensure Billing Department passes annual SOX audit

• Communicates all Role Based Access Model Changes to Security and receives appropriate sign off by business

• Acts as back-up during supervisor's absence to assist with workload prioritization and system issues.

Humana Insurance 03/11-09/11

Insurance Referral Specialist

• Signing up members who already is an Humana

• Humana Medicare Supplement plans to Humana Cares health support plan

• Providing members with their own Personal HealthCare Coordinator or Registered Nurse

• Create a Case for each member, Task, Assign to HCM/PHC,Build Case,

• Create Case Notes, Create Consent Forms, also Create an MDAT.

Apria HealthCare 6/10-02/11

Collection Representative

• Collecting from Insurance companies, not individuals

• Researches any overdue account balance that is fully or partially unpaid and follows up by mail and/or phone to insurance carriers or customers on delinquent payments A/R

• Reviews claims denied for payment and underpaid claims. Verifies payment information adjustments to supervisor

• Coordinates collection activities for delinquent accounts by preparing information for external collection agencies or attorneys

• Complies with the Fair Debt Collector Practices Act (FDCPA)

• Responds to customer inquiries regarding account status

• Researches customer's accounts thoroughly and documents appropriately

• Resolves discrepancies and prepares adjustments and refunds as necessary

• Coordinates collection agency communication

• Ensures that all information regarding collection activity of account is entered accurately into the billing system

• Brings recurring issues to the attention of the department supervisor

• Initiates payments and resubmits bills as necessary

• Pursues patient for payment obligations when insurance defaults as permitted by law or contractual relationships

• Performs other related duties as directed by supervisor

Bright House Networks

Business Solutions Collections 12/09-06/10

Commercial Billing

• Responsible for generating payments and minimizing delinquent commercial accounts, contacting business solutions customers

• Review customer account to determine reason for delinquency (service/billing issues), collect and process a payment, make payment arrangements

• Enroll customers in the easy pay program, work from the generated report of non-pay status, utilize both ICOMS and close tabs for account research and information

• Process: Type of service- Work Order History- payment history- notes, utilizing the customer call script / making 25-50 calls per day, service Issues- payment- payment arrangement- manager review adjustments - credit and or/debit late fees/viewing statements finding- Excel Spreadsheets for Billing Accounts, Scanning Documents, E-mailing Clients Billing Statements, Payments, Receipts - RRBC Accounts/Recognizing Bulk HSD Accounts Corporate Connections/ National Sales/ Bankruptcy Accounts

Faneuil Company 06/09-11/09

Sun Pass CSSR Rep

• Responsible for inbound/outbound calls, terminating/activating accounts, closing accounts, processing balance transfers and credit cards & check refunds, adjusting accounts

• Collection on past due accounts, opening new account numbers

• Providing customer service to Sun Pass customers, Processing commuter passes for Bay Way, replenishing accounts, verifying balances

• Educating our customers on the website violations, processing accts for auto-replenishment

QAS Services 06/08-10/08

Medical Insurance Coordinator

• Answering inbound/outbound calls, making calls to insurance companies

• Verifying Insurance info, scheduling medical orders, supplies, and deliveries, medical supplies

• Processing EOB'S, AOB'S, PFFT's, COB's

• Re-submitting claims, adjustments, collections, billing & coding, utilization management,

• Medicare/Medicaid, Medicare Replacement Plans, Medicare Advantage Plans Private Insurance's, processing claims. Mysis Systems, Medic Systems, FOI’s Web MD, Utilize MediFax,100-300 CPD.

Clermont Dialysis Center 01/05-05/08

Medical Office Coordinator

• Answering incoming calls, making outbound calls to patients for scheduling, taking payments, co-pays, credit cards payments

• Handling HMO's and Referrals, payment processing, checking patients in & out

• Admitting patients for surgery, appointments billing & coding and verifying insurance information

• Input all patients’ info into medical Mysis system; call other doctors for reports on referral pts.

• getting patients history: weekly, monthly, Bi-weekly Labs, & Lab Reports

• Taking Pts., Vitals, Front & Back offices. Etc.

• Medical Mysis Billing System & 32 Other Billing systems.

Sprint PCS Wireless 05/03-12/05

Sales Account Representative

• Business to Business sales, generating new leads

• Making 200-300 calls per day on an automated dialer

• Call center atmosphere: calling small businesses to see if they will switch providers for their corporate accounts

• PCS Wireless, Payment Processing, Collections

• Significantly increased revenues and grew client base between 2003 and 2005.

CCN First Health02/-99-12-02

Provider Relations Rep

Customer Service, reviewed and audited EOB's, PPO's, HMO's and POS, verify provider's credentials to sign up to the network, follow up on aged insurance accounts and patient AR charge entry, verify patients’ insurance cards, S.S. date of birth and payment postings, file medical appeals, review, research, and resolve denied claims, inbound & outbound predict dialer, medical billing call center, handled over 300 calls per day, payment processing, call on accounts 60-180 days past due, adjusted claims. WebMd, Utilize Medifax.

National Market Shares Inc. 09/93-06/00

Customer Service Rep/Sales Executive

• Outbound Call Center: High Call Volume, 200-300 calls per day

• Responsible for selling various services from Xerox machines to Corporate Credit Cards Companies To Small-Medium sized Businesses

• Very fast paced Environment

• Collections 3rd-party, Skip Tracing

• Significantly increased revenues and grew client base between 1993 and 2000.

Bank Of America, Call Center

Customer Service Representative 01/90-12/95

• Assists customers with questions or issues regarding their accounts,

• Receive via phone correspondence/100-200 calls per day.

• Routine calls/but there are deviations from standard screens, scripts,

• Procedures. Respond to email, faxes, mail. System tracking information

• Gathering & troubleshooting products & services, problem solving.

• Research Accounts for errors, Over Drafts, Account Issues, Transfers.

• Knowledge of Credit Card terms, multi-task, High Call volume environment.

• Perform User Acceptance Test (UAT) for AML system initiatives, specifically, evaluate the components of `the test that rely on the Investigative Analyst perspective. Perform system regression testing where necessary

• Be capable of reviewing alerts on the system and follow standard AML investigation process as defined by Operations Procedures to ensure the testing of systems functionalities has a deep perspective of an analyst requirement

• Work with automated testing tools such as Test Director or HP Quality Center

• Help to evaluate external IT testing methodologies, and upcoming tools supporting management on adopting them when applicable

• Help design, develop and implement test plans, scripts, and tools using the detailed business requirements document provided by the business analysts

• Independently conduct searches, gather data and record evidence from Citi internal systems, the internet, commercial databases and enquiry with business or Compliance contacts within Citi as part of the emulation of operational procedures for testing

• Building and applying knowledge of anti-money laundering processes

South East Bank 02/82-10-86

Business Admin- Customer service Collector

• Outbound/Inbound calls, Collections, Customer Service, Loss Mitigation/Recovery

• Contacts delinquent accounts, charge off, high risk customers, to secure payments,

• Determine reason for delinquent/ on active loan/credit card accounts.

• Implement repayment plans/settlements. Resolve billing inquiries/negotiate payments.

Education

Galliano Career Academy 02/03-08/05

Altamonte Springs, FL

• Medical Administration Assistant

• Medical Assistant,

• EKG Technician

• Phlebotomy

Contact this candidate