Insurance Service Representative

Vanessa Pinkney

*** ******* **.

Baltimore, MD **217

Day Phone: 410-***-****

Email: ****************@*****.***

Country of

citizenship:

Veterans’ None Status

Preference:

Contact Current Yes

Employer:

BLUE CROSS BLUE SHIELD 4/2000-6/2011

WORK Claims Department

EXPERIENCE Owings Mills, Maryland

Grade Level: GS-6

Hours per week: 40

CLAIMS REPRESENTATIVE II

SERVICE REPRESENTATIVE FOR PRECERT DEPARTMENT verifying

patient registration by obtaining the necessary referral and medical from their

Inpatient/Outpatient clinical and hospital institutions and required authorization.

Gathered pertinent patient information for further verification. Concealed

confidential patient information via hippa laws. Answered incoming calls and

addressed client concerns in a call center environment.

CLAIMS PROCESSOR FOR PATIENT ACCOUNTS ensuring deductibles were

paid by the patient as required. Upon receipt of payments, prepared voucher for

approval and delivery to finance office. Monitored invoices closely to insure that

duplicates were not included. Ascertained that co-pays were correct according to

family members’ status and services rendered according to patient benefits.

Ensured that co-insurance and other health insurance were paid when

appropriate. Created and dispersed all claim and invoice payments.

MONITORED THE STATUS ON CLAIMS by reviewing information to

determine if further development of claim material was needed. Collected

additional information to develop claim. Coordinated the investigation of

specific details with insurance company or others. Resolved problem claims via

phone.

KEY ACCOMPLISHMENTS:

+ Gained advance knowledge in managed care.

United States of

America

the Service Representative position CUSTO + Gained an in-depth knowledge in

to the Claims Representative II MER regards to the third party industry.

position SERVIC

E OAK VIEW TREATMENT

WILSE AND ASSOCIATES AGENT CENTER 1990-1998

9/1999-5/2000 for Ellicott City, Maryland

Third Party Insurance patients

Baltimore, Maryland with Grade Level: GS-4

problem

Grade Level: GS-5 claims. Hours per week:

Manage 40

Hours per week: d phone

40 calls UNIT SECRETARY

regardin

FULL SERVICE g patient UNIT SERETARY FOR

REPRESENTATIVE concerns SUBSTANCE ABUSE PROGRAM

. managing patient hotline.

MANAGER FOR THE THIRD Resolve Counseled patients calling in with

PARTY COLLECTION d claim problems regarding drug abuse and

PROGRAM (TPCP) coordinating issues in suicide. Forwarded serious cases to

with clinics and services and the a helpful the proper authorities.

medical screening process. and

Coordinated directly with Medicare timely

patients and other applicants. manner.

Reimbursed healthcare beneficiaries Address

according to prescription plans and ed and

benefits. respond

ed to

MAINTAINED A KNOWLEDGE patient

OF HEALTH SERVICES email

COMMAND DOCUMENTS correspo

specifying procedures and ndences EDUCATION

regulations for the Third Party on

Collection Program. behalf

of the

MAINTAINED WORK REPORTS compan

containing employee progress. y.

Documented daily volume of claims TRAINING

processed by Full Service KEY

Representatives. Submitted work ACCO

+Earned reports daily and weekly to MPLIS

a supervisor. HMENT

promoti S:

on from ADDITIONAL INFORMATION

was necessary and if other mental VOLU

conditions were present. Handled NTEER

outpatient scheduling. Checked ACTIVI

patient charts. Verified patient TIES:

registration with marketing staff and

doctors. Baltimor

e, MD, 5

ADMINISTRATIVE OFFICER hours

FOR UNIT handling staff training. per

Purchased office and medical week,

supplies. Recorded staff time and 9/2011

attendance. Answered phone calls. to

Faxed, copied, scanned, and filed 6/2012

documents. PAREN

T

BOWIE STATE UNIVERSTIY VOLUN

Business Management TEER:

MANA Seeking B.S. in Business Assisted

GED Management; 24 credits completed in

PATIEN in total directing

T parents

PROFIL HOWARD HIGH SCHOOL, during

ES by ELLICOTT CITY, MD 1981 after

intervie care

wing BLUE CROSS BLUE SHIELD, pick up,

and in MD US, 2011 distribut

processi Computer Software Classes: ed

ng Microsoft Excel, Microsoft school

substanc PowerPoint, Microsoft Word informat

e abuse ion to

patients. Hippa Privacy Act Training parents.

Gathere

d patient COMPUTER SKILLS:

insuranc + Type 43+ WPM.

e +Word and Basic Excel – create and

informat update spreadsheets

ion. +Outlook and email management

Determi services

ned +Power Point – development and

whether updates

or not +Internet (Explorer) – research

psychol skills

ogical

testing

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