Customer Service Manager
Resume:
Wilma L. King
Indianapolis, IN 46235
Phone: 317-***-****
Professional
Experience
Availity L.L.C. Client Services Representative
Client Service Representative responsible for working with the transactions processing system and document with
customer service contact from users service as a help desk associate and serve first level support for Web/EDI issues that
need document the resolution provided as training to user as necessary. Create and reset password for accounts, interrupt raw
data and pass on to providers from payers. Work in call center environment at fast pace.
(Rehired back at Community Hospital
Community Hospital Epic Project June 2012 –12 2012 Super User Trainer/Analyst
Epic Application for Inpatient Nursing, Provider, Front Desk, Technologist and Interventional Radiology
Assist end users with training on new system
Work with Epic questions and answers in determine if materiel issues are related to process or if problem is in the application
program to refer on to implementation department for changes.
Work with meaningful information suggesting resolution from collective data.
CarDon & Associates 06-201*-**-**** Full-Time – Business Office Manager
Census update of new admits and discharges, expired residents
Verify Financial Insurance Documentation
Billing of Medicare Claims on Ivan Medicare System
Responsible for patient liability for Medicaid individuals
Work with Medicaid Caseworkers for new applicants and deviation
Reports census changes to Management
Daily Manuel Census excel report keeping
Collection of monthly rent from residents and/or family members
ePREMIS system for unloading submission of claims
Matrix software system
Collection on pass due accounts
Community Hospital North - 06/2006-06/2011 (Part-Time) - Administrative Partner
Customer Service
Charted orders for patients for upcoming tests
Assisted and educated patients and family members with information
Observed and reported patient behaviors to nursing staff
Coordinated activities for Charge Capture
Entered charge entries into system for reimbursement
Organized and managed forms for entire department
Recorded data regarding patient care on Midas System record keeping
National Government Service - 09/2008-10/2009 - Auditor I
Provided detailed explanation of audit review outcome
Reviewed financial reports auditing year ending
Recommended findings from an extensive review to management team
Completed working papers for limited desk reviews for hospitals, skilled nursing facilities, and end stage renal disease facilities
Reviewed provider financial records and allocations for reimbursement settlements
Disetronic Medical System now Roche Diagnostic - 05/2004-09/2008 - Insurance Reimbursement Specialist in Medicare
and Medicaid
Customer Service queue phone system of incoming calls for medical insurance questions and sale of product
Evaluated customer’s financial status and made recommendation regarding accounts
Trained other departments including contract, customer service and sales
Set up standards in daily processes
Monitored collections, developed, and prepared reports to track financial and operational performance
Implemented training program and guidelines for government contracts
Working from customer service queue system inbound calls and outbound calls.
Managed collections on customer accounts
Reviewed case management for patients’ care
Collected and reported monthly accounting to manager and director for review
Worked with Administrative Appeals Judge through phone hearings regarding denied and unpaid claims
Collected refunds and credit balances
Verify pre-certification diabetes product and also receiving of documentation of Certification of Medical Necessary and
prescription for medical supplies.
St. Vincent Hospital Emergency Room Department- 12/99-04/2006 - Administrative Assistant (PRN)
Applied charges from services provided by emergency staff members
Ensured accurate billing
Served customers
Charted patient information
Veteran’s Administration – 04-200*-**-****- Account Receivable Rep
Work with utilization nurse on high dollar accounts for servicemen/women and their family to get reimbursement for denied
claims.
Post large insurance payments to accounts
Review status of accounts bad debt and credit balance to supervisor and manager experience working aging accounts.
Verify accounts for benefits for members.
Set up hardship accounts for veterans for pharmacy needs.
Anthem Health - 04/97-04/2001- Claim Adjuster
Analyzed process for large dollar amount claims
Reviewed fraud & abuse cases
Reviewed outreach treatment for patients
Evaluated health insurance claim for future payments of care for injuries
Consulted with medical experts in settlement of claims
Work reviewing accounts for fraud also reviewing policy renewals.
Methodist Hospital 02/93-04/97 (Registrar)
Work with the registration of patients for services; x-ray, surgery, labs and the collecting of co-pays and deductible for service
render. Review patient insurance for pre-cert and submission for claims to be paid.
Education
Bachelors in Accounting
Master’s in Healthcare
License: Pharmacy Tech
Foster care license
Knowledge and Skills:
Microsoft Office, Excel reporting, Audit sampling software, Indiana Compliance Laws and Regulations, Interim Rates, Tentative
Settlement, Trend Reports, Certificate in Medical Coding, Registrar, Grievance, Patient Financial Service, Goldmine, TIM’s,
Oracle, GLAS, Tandem, Citrex and Matrix, Trace Scheduling System and EPIC. ANSI 837’s and 835’s Health Care Claims
Compliances. EPIC System on projects Work with developing “Frequently Asked Questions”, “How-to-Steps" Work arounds
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