Customer Service Manager
Resume:
Sandra C. Gregory
Dallastown, PA. 17313
*********@*****.***
Profile
Seasoned Manager with 11 years of successful Billing/Collections, Client/Customer service and Contracting experience.
Extremely conscientious with superior analytical skills for interpreting exceptionally complex materials and technical data.
Skills and Experience
Symphony Diagnostic Services No.1, Inc. DBA MobilexUSA ~ Sparks, MD.
www.mobilexusa.com
08/2009 ~ 07/2012 ~ Provider Relations Manager of Managed Care and Commercial Insurances
06/2008 ~ 08/2009 ~ Provider Relations Supervisor of Managed Care and Commercial Insurances
09/2007 ~ 05/2008 ~ Provider Relations Analyst
02/2005 ~ 09/2007 ~ Provider Relations Representative
Negotiates, executes and maintains oversight of all Providers’ regional and national Contracts/Agreements to include UHC,
Aetna, Humana, Coventry as well BCBS Payors with the addition of Pennsylvania’s IBC and Highmark to name a few.
Administers daily investigations of complex claims issues and escalated denial situations including but not limited to NPI’s, Tax
Id’s, Provider Numbers, Practice Location addresses, etc. to determine and resolve revenue shortfalls while preserving client and
patient satisfaction.
Examines EOMBs, correspondence and initiates self generated reports to identify and remedy patterns of improper payments,
suspicious and/or erroneous language for denied services of CPT codes, HCPCs etc.
Acts as a liaison between the company and the Insurance Carrier/Payor community to resolve discrepancies related to faulty
claims adjudication systems and improper claims processing while establishing and maintaining respectable business relationships
with Corporate Claims Directors among many national Managed Care Organizations /Payors.
Initiates ongoing research and documents critical claims billing related information by successfully navigating Government and
Commercial Healthcare websites.
Identifies internal billing deficiencies and implements corrective procedures to ensure claims processing accuracy while adhering
to corporate policies, regulations and HIPAA compliance.
Performs as a professional role model and ensures that staff is equipped with innovative, valuable billing tools and conducts
training, and mentoring sessions as applicable.
Counsels Sr. Director of Billing/Provider Relations and VP of Reimbursement on vital billing recommen dations, compliance
priorities as well as reimbursement strategies.
Conducts meetings with and educates Carrier/Facility Billing Claims Managers, Cash/ Collection Manager, Refunds Manager,
Systems Billing Manager, Customer Service Representatives as well as Regional Customer Call Centers, Regional VPs, Regional
VP’s of Sales and Sales personnel.
Delivers the utmost customer and client services techniques expected.
Implements daily functions to include Windows Microsoft Office Suite, Outlook/ Excel/Word/Powe rPoint, IDX, Cognos
Impromtu/Analyzer.
Interviews, hires, trains, coordinates, monitors productivity and commends employees in recognition of their achievements and
milestones.
Accomplishments
Achieved reparation of over $1,500,000.00 owed for underpayment of CPTs/HCPCs while increasing yearly revenue over
$1,200,000.00 to date.
Executed proposals to revise Payor contract rates and increased yearly revenue by $600,000.00 to date.
Received certificates to include Leadership for Results Training, Employee of the Month, Team of the Month, Power of One and
additional awards for Provider contracts negotiations.
Sandra C. Gregory
192 S. Franklin St.
Dallastown, PA. 17313
*********@*****.***
Symphony Diagnostic Services No.1, Inc. DBA MobilexUSA ~ Sparks, MD.
www.mobilexusa.com
07/2001 ~ 02/2005 ~ Customer Service Claims Representative and Health Insurance Investigator
Efficient submission of HCFA 1500 claims, now known as CMS 1500, to Primary, Secondary, Tertiary insurances and patients
when applicable.
Updated and maintained patient accounts in IDX and DDF billing systems.
Compiled and documented, via excel, various types o f nationwide health insurance products/plans to include, claims addresses,
subscriber Id formats, claim formatting procedures, contact information etc. for the Corporate Billing Center staff.
Maintained EOMB files containing all Third party payments/denials/correspondence.
Assisted in preparing audits and executed several special research projects.
Education
Graduate of South Carroll Senior High School ~ Eldersburg, MD
Graduate of New Choices/New Options Program ~ York, PA
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