Customer Service Insurance

Michelle M. Travis

***** *********

Sugar Land, Texas 77498

Cell : 281-***-****

E-mail: *******@*****.***

PROFILE: Eight years’ experience working in a call center environment

Strong verbal, written and listening skills

Ability to multitask, organize and prioritize workload

Team player

Quality focused

Able to communicate confidence on calls

Decision making skills

Math skills and analytical ability

RELATED EXPERIENCE

MEMORIAL HERMANN HOSPITAL SOUTHWEST, HOUSTON, TEXAS

2010 TO 2011

PATIENT ACCESS REP III: Obtained demographic, insurance and financial information from patient or

guarantor. Entered information in computer system with a high degree of accuracy. Explained all required

forms to the patient or guarantor and obtained the necessary signatures. Ensured medical necessity

compliance by obtaining necessary data, reviewing Compliance System, communicating information to

patient or guarantor and obtaining necessary signatures. Protected the financial integrity of the facility by

collecting patient liability, establishing payment arrangements, discussing payment options and screening

for eligibility. Identified alternative resources for financial reimbursement. Verifieed insurance eligibility

and benefits and ensured all notifications and authorizations were completed within the required

timeframes. Monitored, reviewed and resolved patient account issues on assigned reports.

INFANTS, CHILDREN AND ADOLESCENTS, MISSOURI CITY, TEXAS

2009 to 2010

PATIENT ACCOUNT SPECIALIST/INSURANCE FOLLOW-UP REPRESENTATIVE: Prepared and

submitted client billings. Responsible for researching and collecting unpaid/ denied insurance claims.

Filed appeals where applicable,verified contracted rate applied correctly, calculated correct adjustments to

patient's account. Collected additional monies from patients with regard to their account, i.e., copays,

deductibles and coinsurance. Updated the patient account record to identify actions taken on the

account.Balanced out daily and monthly reports,enterd money received from insurance companies and

patients into Microsoft Excel spreadsheet. Verified patient eligibility and effective date of plan. Verified

members' copay, deductible and whether plan was self-pay or fully funded.

UNITED BEHAVIORAL HEALTHCARE, INC., HOUSTON, TEXAS

2002 to 2008

CUSTOMER SERVICE PROFESSIONAL: Responded courteously to all phone inquiries from both

members and providers in regards to member eligibility, quoted benefits, provided claim status. Educated

callers on behavioral health programs and procedures. Provided information on the appeals process,

sent back claims for reconsideration if processed incorrectly and to reflect correct benefit level. Educated

providers on prior authorization requirements, how to access services and other routine, non-clinical

issues. Initiated or faxed necessary forms to providers for outpatient therapy services. Coordinated with

Provider Relations regarding contracting and/or credentialing status. Documented all members’ issues

and resolution in the computer systems. Projected patience, empathy, caring and sincerity in voice tone

and words.

AETNA U.S. HEALTHCARE, INC.SUGARLAND, TEXAS

2000 to 2002

CUSTOMER SERVICE PROFESSIONAL: Served as first point of contact for members to Aetna ’s

inbound call center. Responsibilities included, but not limited to the following: Analyzed accounts to

resolve billing inquiries, interfaced with a variety of people both internally and externally in a diplomatic

manner, consistently applied knowledge required to perform technical and procedural aspects of the

position, handled sensitive and confidential records, conducted outbound calls as required.

DILLARDS, SUGAR LAND, TEXAS

2000 to 2000

CUSTOMER SERVICE PROFESSIONAL: Responsibilities included working in the cash room entering

cash and check information into a daily log, balancing worksheet and corrected discrepancies. Acted as

relief switchboard operator and receptionist, helped customers at the walk up counter with regards to their

credit accounts, and processed transactions on the point of sale terminal.

PROFESSIONAL ACCOMPLISHMENTS

AETNA U.S. HEALTHCARE, INC.

Received recognition for Outstanding Customer Service, 100% quality on all calls monitored by the QA

Team

UNITED BEHAVIORAL HEALTHCARE, INC.

Received multiple recognitions for Outstanding Customer Service, 100 % quality on all calls monitored

EDUCATION

Volunteer State College, Gallatin, Tn, Human Services, Cum Laude, 1993

St. Agnes Academy, Houston, Tx, Diploma

Massey Business College, Houston, Tx, Certificate

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