Customer Service Medical
Resume:
Karley A. Primrose
San Jose, CA 95121
OBJECTIVE:
A position in the medical field which will utilize my experience, capabilities and
training.
QUALIFICATIONS:
DE ANZA COLLEGE, Cupertino, CA (1993-1996)
Honors Graduate
Certificate of Completion in Medical Reception
Certificate of Completion in Billing and Coding
KNOWLEDGE and ABILITIES:
Medical Communications Applied Anatomy & Physiology
Telephone Communications Medical Terminology and Common Diseases
Business English Medical Office First Aid
Medical Office Reception Medical Law and Ethics
Medical Office Management
Medical Office Billing and Coding Word Perfect, Word, Excel
Hospital Billing and Coding MS DOS and Macintosh
ICD-9 and CPT-4 Coding Filing and Data Base Management
Medical Office Financial Procedures 10 Key & Calculator
Claims processing system running on AS-400 with Windows based user interface.
MEDICAL-CLERICAL EXPERIENCE:
EXCEL M.S.O., San Jose, CA (October 20, 1997 to June 23, 2011)
Medi-Cal Claims Adjuster/Customer Service Representative
Medi-Cal Claims Adjuster/Customer Service Representative. Processing claims
for payments or denials. Verify eligibility of members, and auditing processed
claims. Customer service representative on telephone, for doctor and member
inquiries.
Educated physicians office as to correct procedure and diagnosis codes.
Specialized in Emergency room claims and Medi-cal claims. Used DOFR's to
determine whose responsibility the payment is. Check providers contracts to see
how to pay the claim.
SAN JOSE MEDICAL GROUP, San Jose, CA (April 22, 1996 to October 17, 1997)
Health Maintenance Organization, Clerk
Medical claims Adjudicator, processing claims for payments or denials. Verified
eligibility of members, and updated eligibility information into the computer
system. In charge of pulling claims for audits. Back-up mail room person.
Reviewed claims for correct ICD-9 and CPT-4 codes for the coding
department.Did hospital billing and coding for San Jose Hospital.
SAN JOSE MEDICAL GROUP, San Jose, CA (March 11, 1996 to April 19, 1996)
Billing and Coding Extern (160 hours)
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Karley A. Primrose Resume Page 2
Clinical and hospital coding for HMO dept. Filed claims, and claim’s adjuster for
physician payments.
MISSION DE LA CASA, San Jose, CA (Nov. 22, 1994 to Dec. 12, 1995)
Medical Records Clerk
Responsible for weekly audits of Physicians Orders, Nurses Notes, and Pharmacy.
Prepared new charts for nursing floor. Collapsed discharge charts. Responsible for
all medical records filing in this 160 bed nursing and rehab. facility. Back up front
desk receptionist, as needed.
STANFORD INTERNAL MEDICINE CLINIC, Palo Alto, CA (1994)
Medical Receptionist Extern
Checked patients in and out of clinic. Scheduled appointments, and called patients
with appointment reminders. Collected copayments. Verified Medi-Cal and
Medicare Eligibility. Retrieved E-Mail request from pharmacies for refills. Called
Pharmacies back after physicians approved request. Coded clinical diagnosis and
procedures. Pulled and updated patients files.
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