Customer Service Quality Assurance

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|*** W. Emelita Ave. Mesa, AZ ***** 623-***-**** Cell |

|*******@*****.*** |

|CASAMIDA C APOLINAR |

|Objective |

|To obtain a feasible position while attending school. I am greatly |

|experienced in customer service, have good people skills and work well|

|with others. |

|Experience |

|07/2003- Present |Sports & Entertainment Services |Phoenix, Az |

|Security Officer |

|Duties include: Search all bags coming into the facility to ensure no |

|items that are prohibited get in. Assist all guests with all issues |

|and/or questions they have. Write up reports for any incidences that |

|was resolved in the facility. |

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|11/2007- 05/2011 |Phoenix Children's Hospital |Phoenix, AZ |

| Reimbursement Specialist |

|Duties include: Compiles and submits appeals and monitors for proper |

|reimbursement, Identifies potential problem areas within current |

|processes and corrects them. Implements process for identifying |

|under-allowed claims using Phynance and other available tools. |

|Monitors and tracks contractual, billing, registration, and posting |

|errors. Reviews and analyzes EOBs for identified under-allowed claims.|

|Verifies applicable contract by reviewing EOB messages, reviewing |

|patient ID card, and verifying member information for managed care |

|plans. Take incoming calls from patients, and providers with questions|

|or information pertaining to specific accounts. Perform miscellaneous |

|job related duties, as assigned |

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|08/2006- 11/2007 |Apria Healthcare |Phoenix, Az |

|Senior Suspended Billing Representative |

|Duties include: Checking all work orders to assure they are correct. |

|Make sure we have all appropriate paperwork. Evaluate completed |

|CMNs/prescriptions/authorizations/prescriptions to ensure appropriate |

|information has been obtained to allow reimbursement. Contact patients|

|and Dr to gain involvement in problematic situations, researches |

|diagnosis and insurance benefits to receive proper reimbursement. |

|Assists in obtaining authorization for reimbursement for accounts.k |

|for insurance billing and qualification. Prior to QA representative |

|did patient services. |

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|11/2005- 08/2006 |Western Medical |Phoenix, Az |

|Quality Assurance Representative/ Team Lead |

|Duties include: Checking all work orders to assure they are correct. |

|Make sure we have all appropriate paperwork for insurance billing and |

|qualification. Prior to QA representative did patient services. |

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|Education |

|2011-2012 |Pima Medical Institute | |

| | |Mesa, Az |

|1989-1993 Trevor Browne High |

|Phoenix, Az |

|References |

|References are available on request. |

Contact this candidate