Customer Service Quality Assurance
Resume:
Sylvia Johnson
North Chicago, IL ***64
Mobile: 847-***-****
Email: **********@*****.***
Availability: Job Type: Permanent
Work Schedule: Full-Time
Work Experience:
DEPARTMENT OF THE NAVY
GREAT LAKES, IL United States
11/2008 - Present
Hours per week: 40
Supervisor: Lennie Orlik (847 688-5550X439)
Okay to contact this Supervisor: Yes
Dynamic communicator across diverse groups and all organizational levels.
Provides superb customer care that thrives in high-pressure, deadline-
sensitive situations that demand a rapid learning curve and inventive
problem solving. Now looking forward to a making a significant contribution
with an ambitious Customer service agency that offers a genuine opportunity
for progression.
Knowledge, training and practical experience with various Care systems:
(HMO) Health maintenance organization, (PPO) Preferred provider
organization, (POS) Point of service, Medicare, Verification of Insurance
Benefits, secondary insurance, Medicare supplements insurance, billing, and
collections. Very knowledgeable of (HIPPA) Health Insurance Portability
and Accountability, (HCFA) Health Care Financing Administration, (CPT)
Current Procedural Terminology, and (ICD9) International Classification of
Diseases.
Department of Defense Alutiiq
General clerk- 11/2007-Present
Responsible for Auditing Permanent Change of Station settlements, temporary
Duty and Advance Travel entitlements. Responsible in operating a computer
terminal to transcribe, verify, and transmit data into different computer
systems such as Master Military Pay Account (Active Duty), Master Military
Pay Account (Reservist), and Navy Standard Integrated Personnel System
(NSIPS) data. Transferred over 300 service members in an effective and
timely manner utilizing TOPS (Transaction Online Processing System).
Provide timely, efficient and courteous service to customers.
Department of Defense Military Medical Support Office
General clerk IV - 11/2008-10/2009
Managed claims processing to key and examine all types of claims and
identify key elements and processing requirements based on coding,
provider, plan benefits, contracts, and policies and procedures.
Efficiently and accurately process all types of claims, utilizing broad
based product or system knowledge to ensure accuracy and timely payment.
Calculates co-pays and maximums, as well as researches and resolves claims
inquiries from internal and external customers as well as resolves pended
and rejected claims. Works with other departments to complete claim
processing and resolve over and underpayments. Assists customer service
reps by providing feedback and resolving issues and answering claims
processing questions. Can assist in training programs and provide
assistance to less experienced staff.
Admedisys home health Baton Rouge, LA
Billing and Collection Specialist - 09/2007-12/2007
Applied payments and adjustments to patient accounts, processed deposits
and maintained accurate records of all cash received in a timely manner and
in accordance with company policy. Assisted with quality assurance to
ensured patient satisfaction with Admedisys services as necessary. Complied
with the system of internal controls to ensured proper handling of cash
receipts, including billing system data entry and bank deposits. Followed
up on all opened accounts, maintaining thorough chronological financial
records on each patient account. Maintained accurate and completed patient
files, ensuring that they are in compliance with the Company policies
Caremark Specialty Pharmacy Baton Rouge, LA
Admissions Coordinator for Specialty Drug Synagis - 08/2005-04/2007
Specialties involve management of pharmacy operations, patient relations,
and online insurance claim adjudication referral. Frequent and positive
interaction with many customers, case managers, pharmacists, physicians, co-
workers, and medical office personnel.
Additional skills:
Microsoft Word, Excel, Power point, and Outlook
Education:
College of Lake County
Columbia College
Security Clearance:
Secret
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