Customer Service Call Center

Sandra Hampton Ellis

Phone Number: 817-***-****

E-mail: ad5dxi@r.postjobfree.com

Highly energetic, organized, motivated, and diversified individual seeking a position as a Customer Service Specialist. Unique ability and approach to handle difficult situations by using creative problem-solving skills to diffuse unpredictable situations with both professionalism and courtesy.

Have all encompassing knowledge working in the healthcare insurance industry working for insurance companies such as Blue Cross Blue Shield, United Healthcare, AETNA, Harris Methodist Health Plan, HMO and The Senior Health Plan which includes as call center customer service, clerical data entry, ability to update, file and maintain medical records encompassing the use of electronic medical records. Broad knowledge in medical terminology, CPT Coding and ICD 9 & 10 Codes, medical billing, educating patients and clients on insurance benefits, insurance verification, and negotiation skills for settlements of healthcare claims.

COMPUTER SKILLS: Apple/Mac OS X El Capitan MS Windows OS/7 E-Mail programs: MS Outlook and Yahoo

Microsoft Office Suite – Word Perfect, Power Point, Excel, and Access Adobe Photoshop EMR – EPIC and Next Gen

CAREER EXPERIENCE:

Cornerstone Staffing Temporary assignments from December 4, 2023 to February 15, 2024

Last Assignment - Benefit Verification Specialist at CareMetx – Remote position

Pacific Dental Services - Contact Center Specialist – Irving TX March 3, 2022 to November 2022

Schedule appointments for patients, maintain patient accounts and records, Assist patients in filling out required intake and medical forms, confirm appointments with patients via phone or email, manage and organize specialist referrals, inform patients of payment options if applicable, update patient insurance information, responded and resolved routine inquiries, complaints and concerns through inbound phone calls, emails and electronic requests, ensured a positive and exemplary experience with all customers by focusing on customer satisfaction and scheduled appointments for patients, maintain patient accounts and records, assist patients in filling out required intake and medical forms.

Achieved high performance metrics evaluations for call handling ability and quality of services provided to patients and customers in a fast paced, high volume call center

Baylor Scott and White, Contact Center Specialist (remote) - Dallas TX, November 2020 to October 2021 **Same job duties and responsibilities as above with Pacific Dental services**

Aleron Company through Acara Solutions, Sent to HMS – Health Management Systems – Irving, TX Temporary to Permanent Position – Subrogation Specialist - From June 2019 to June 2020

Assisted with the investigation and adjustment of claims by making outbound phone calls to Attorney’s offices, Medical Providers offices, patients/clients and other insurance companies

Responsible for preparing case files and handling paperwork

Collaborated with the subrogation council and negotiated settlements

Knowledge of insurance claim procedures, confidentiality, critical thinking, decision making, time management, and computer competences

Reviews claim files to identify, evaluate, analyze and interpret subrogation potential;

Coordinates appropriate steps to secure evidence and ensure pursuit, development and recovery of claims

Evaluates completeness and accuracy of documentary evidence; and records If recovery is completed, ensures policyholders are reimbursed the deductible amounts.

Multiplan, Out of Network Claims Resolution Specialist – Negotiator - August 2011 to March 2019

Contacted providers to reach a mutually agreeable discount on billed charges that can't be reduced through a network contract

Signed an agreement confirming the new amount due and that they will not bill health plan members the difference between the original and negotiated charges

Ability to determine what needs to be done for each individuals specific situation or issue, use stress tolerance and resilience skills to deal with what others are saying, doing, or may need help with to perform job correctly and the ability to abide by company policies in dealing with customers issues

Prepared claim forms and related documentation to be processed

Reviewed claim submissions and verifying the information

Recorded and maintained insurance policy and claims information in a database system

Generated all reports related to the appeals process for review by the appeals Coordinator

Maintained knowledge of all system, contractual, compliance standard changes and policy updates, and attend additional training sessions as necessary

Processed all administrative appeals and presented to the Administrative Appeal Committee for resolution

Maintained knowledge of all system, contractual, compliance standard changes and policy updates

Determined policy coverage and calculated claim amount

Assisted member or provider, or provider on behalf of the member, in filing a formal appeal and grievance

Managed the receipt, investigation and resolution of standard complaint and appeal issues

EDUCATION:

Concorde Career Institute - Medical Insurance Coding and Billing Specialist Program, From 2008 through 2009, Non-Degree Program

Education America now D/B/A Remington College - Associates of Applied Science Degree in Computer Information Systems – From May 2000 through October 2001

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