Customer Service Medical
Resume:
JACQUELINE S. COOPER
***-** ****** *********, ****** Hills, NY 11375
E-mail: **********@***.***
EMPLOYMENT
TOUCHSTONE HEALTH
Appeals and Grievances Coordinator/Medical Management Coordinator
08//2009-11/01/2010
Medical Management call center responsibilities, coordinated medical
management authorization process with provider and medical management
staff. Well in versed in medical management process, coding, and medical
terminology. Transition to Appeals and Grievances Coordinator in November
2009. Responsibilities include Member and Non Participating Appeals and
Grievances. Dept of Insurances complains, and CMS Complaints. Assisted
Director with management of Customer Service escalated problems related to
all aspects of Appeals and Grievances. Assisted the Crediationaling team
with updated provider information. Assisted Manager with all aspects of
Appeal and Grievances. Provided team members with extensive claim denial
knowledge and coding.
Customer Service Representative and Escalation Team
10/2007-8/1/2009
Call center responsibilities answer high volume calls (50-80 daily).
Trained new hires in the customer service e systems such as KWIK, MCAS AND
ACUITY and EXCEL. Met all departmental standards for productivity,
quality, adherence and teamwork. Assisted member/providers with
eligibility inquire, benefit questions, coding, referral/authorization
inquires, appeal and claim status.
Escalation team - Handled complex review of claims and benefits inquires.
Updated and changed member PCP changes. Review complex details of appeal
and grievances, and then follow up on if appeal was processed correctly.
Advising providers on what action to take on appeals status. Organized
member reimbursement claims for vision and over the counter pharmacy
benefit. Processed claims for payment for members. Assisted with
credentialing projects. Interacts with internal departments to ensure
proper resolution to member and provider issues. I worked to resolve
extensive PCP projects in conjunction with IT.
NYU FACULTY PRACTICE RADIOLOGY
9/2004 -3/2006
Insurance Follow Up/Billing Representative
Process and rebill inpatient and outpatient Radiological claims. Review
eligibility for all insurance's and Medicaid and Medicare. Review and
question denial codes for claims. Updated denial claims and reprocess
accordingly. Process and review claims in IDX System. Update eligibility
status in IDX System. Prepare and process appeals. Prepare and work on
Excel Spreadsheets
ELMHURST HOSPITAL-OUTPATIENT FINANCE
Elmhurst, NY
Billing and Collections Clerk
9/2003 - 1/2004
Process and rebill outpatient claims, review eligibility in Unity Database.
Process arid review claims in SMS System. Review and question denial codes
will, all Insurance Companies. Update denial diagnostic codes for claims
PROFESSIONAL EXPERIANCE
UNIGLOBE AT BEST TRAVEL
New York, NY
Senior Corporate Agent
9/1997-1/2002
Provided significant administrative support to the Director of Travel
Services. Impressively managed
Complex international travel arrangements. Acted as a resource person and
readily assisted junior agents
With all their responsibilities. Maintaining an extensive filing system,
with detailed sub-files for
Individual itineraries. Provided heavy telephone support. Adeptly logged in
and monitored all work
performed, upgrading clients, responsibly organizing and implementing a
range of promotional activities
to increase the 'bottom-line.' Originally hired as Junior Corporate Agent
(1997-1999) and received
promotion based on outstanding performance, meeting and exceeding all
stated objectives. Expertly
handled travel arrangements for corporate clients.
TRAFALGAR TOURS
New York, NY
Administrative Reservations Clerk
9/1996-7/1997
Activities focused on the planning, coordinating and booking of
international travel plans. This involved
managing pre-ticketing tasks, creating and updating bookings, handling
schedule changes.
Provided one-on-one advice to agents and clients. Proficiently organized a
large number of flies and kept
the records of all transactions. Routinely interacted with West Coast
office for purposes of exchanging
information and processing reservations. Provided friendly customer service
and was recognized for
maintaining loyalty of client base.
LIBERTY TRAVEL
New York, NY
Administrative Manager's Assistant / Senior Sales Agent
7/1994-5/1996
Oversaw extensive record keeping system. Provided managerial oversight of
agents' accounts, ensuring
accuracy of all recording entries, organizing and compiling daily ticket
reports. Supervised staff, including
their performance while carrying out a range of duties and
responsibilities. Handled general bookkeeping
responsibilities, posting to and maintaining the General Ledger, Accounts
Payable. Prepared daily cash
reports arid bank deposits coordinated travel itineraries, both land and
sea travel. Worked with a wide
range of clients, offering recommendations including hotel accommodations
and restaurants.
EDUCATION
ST. JOHN'S UNIVERSITY- Business Administration Major
1984-1986
QUEENS COLLEGE
Flushing, NY
Medical Billing Certification Program
January 2003
SKILLS
Medical Terminology Medical Billing
Medical Bookkeeping
Medical Manager Managed Care
Inpatient Hospital Billing
CPT Coding/ICD-9 Coding Workers Comp/No Fault Workshop
Medicare Workshop
REFERENCES: Available Upon Request
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