Customer Service Data Entry
Resume:
NICOLE R. O'NEAL
*********@*****.***
Corona, CA 92881
QUALIFICATIONS
. Proficient in Microsoft Word, Excel . Typing (55
wpm)
. Attentive to Detail and Accuracy . Medical
Billing
. Works well without supervision . HCPCS
. Multi-tasking and prioritizing . ICD-9
. Data Entry (14,000 ksph) . CPT-4
EXPERIENCE
Kaiser Permanente, Corona, CA, 2011
Customer Service Representative - Member Services Call Center
* Provide membership eligibility, claim, payment, plan options, billing
inquiries and benefit information (co-pays, deductibles, out of pocket
maximums, etc.) to members.
* Assist members with navigation on Kaiser Permanente website and reset
passwords.
* Provide eligibility, claim, and benefit information to providers.
* Address members' issues of escalated concern.
* Update member demographics.
* Process payments for members.
Health Net Federal Services, Rancho Cordova, CA, 2008 to 2010
Intake Representative I - TRICARE Program
. Validated patient and medical provider information
. Determined whether patients are eligible to receive health care
benefits under the insurance program by determining the patients'
status/eligibility, the Primary Care Manager (doctor) type, and the
appropriate referral/authorization path.
. Contacted medical provider offices by telephone, and makes
confirmation calls to patients for all urgent requests.
. Used sound judgment in making decisions in order to keep the
referral/authorization process moving forward in accordance with
contractual timeliness standards.
. Followed step-by-step instructions, including redirecting patients
into the provider network for care, as required by contractual
standards.
. Formulated brief sentences/paragraphs from referral/authorization
orders and prepares correspondence in business letter format to
provide clinical information to servicing providers.
. Coded, searched, extracted, and interpreted information to ensure
correct input.
. Generated letters and reviews to validate that they are going to the
correct providers/patients, and that the provider/patient demographics
and reason(s) for services to be rendered are correct.
. Met goals and produced results through tracking performance, improving
work processes, and prioritizing work and tasks.
First Data Government Solutions, McClellan Park, CA, 2005 to 2007
Data Entry Workflow Coordinator, Data Entry Operator
. Responsible for training and managing employees
. Responsible for managing production for 25+ employees
. Recognized, addressed, and corrected procedural issues
. Ensured that deadlines were met and exceeded
. Managed disciplinary actions
. Coordinated workflow
. Troubleshoot operator errors
Delta Dental of California, Rancho Cordova, CA, 1995 to 2004
Data Entry Operator, Edit Clerk
. Processed Dental claims
. Verified and corrected operator errors
. Cleared edits for adjudication
. Performed light clerical duties: faxing, copying
Franchise Tax Board, Sacramento, CA, 1991 to 1995
Key Data Operator
. Processed personal and business income taxes
EDUCATION
EGACE - Medical Billing and Coding
Certification of Completion; April 2008
References Upon Request
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