Customer Service Medical

**** *. ****** **. ***** IDAHO *****

PHone 208-***-**** email:********@*****.***

Gara BoŠnjak

Objective

• To achieve a position that will utilize my work experience and education, providing challenging

opportunities for professional growth in a team oriented work environment.

Employment

03/1998-07/1998 Dreamscape Daycare

Licensed Daycare provider

Worked at a busy daycare.

07/1998-11/1998 Micron Technology, Inc.

Production Operator

Achieved certifications in all areas of production in half of the given time.

02\1999-10\2004 Integra Information Technology, Inc.

Team Leader, Scanning Department

Supervised and managed team members and all production activities on day and swing shifts in scanning

department.

Achieved top production volume by maintaining a high degree of accuracy.

Staff training on all hardware and software used in production

Responsible for quality control.

Responsible for ensuring the confidentially of customer records and compliance with all HIPPA

regulations.

Trained as the backup for a Services Technical Facilitator.

Effective communicator. Polished phone, interpersonal and customer service skills. Energetic, patient

and diplomatic.

03/2005-01/2007 EDS/HP

Specialized Support Clerk I – Adjudicator, EDS/HP

Worked independently and as a team player resolving medical claims suspended for edits and audits.

100% Trained and QA On Seven Claim types in two years.

Continuously exceeding Performance Reviews

Submitted data resolution issues to the Reference Team to obtain clarification from the Idaho customer.

Consistently met or exceeded the number of claims to be processed for each claims type.

Detail oriented and strong knowledge of billing procedures.

01/2007-08/2008 EDS/HP

Specialized Support Clerk II – Adjudication Team Lead

Claims adjudication staff oversight.

Provided specialized training for all areas of claims adjudication

Directed daily work assignments

Performed quality reviews on adjudicated claims to meet performance requirements for the adjudication

team.

Monitored aged claims to ensure all pending claims did not exceed the maximum number of days

allowed to meet the standard required by the Idaho customer.

08/2008 – 08/2010 EDS/HP Idaho Title XIX

Reference Analyst

Required to add or update all approved reference updates as requested by the Idaho customer in the

Medicaid Management Information System.

Tracked all requests from support staff and customer in a specialized Access database.

Performed Quality Reviews on all reference file updates.

Created and tested both relationship and limitation audits.

Created and updated resolution instructions for new and existing edits and audits.

Updated existing Tables Manuals with new reference information.

Created production code lists for the systems team to enable them to keep all code lists in all

environments in sync when working on new enhancements to the MMIS

09/2010 – Present HP Enterprise Services MediCal

Provider service support

Supporting MediCal Call Center by providing excellent customer service.

Constantly maintain Quality Monitoring of 98% or higher

Proficient user of CAMMIS and CRM software

Ensures that customers have a positive experience by handling their questions and concerns with speed

and professionalism.

Conform with and abide by all regulations, policies, work procedures and instructions including but not

limited to confidentiality (HIPAA) requirements (patient files and personal information).

Communicates any problem issues to the manager on an ongoing basis.

Provides a positive work atmosphere for the team and the department

Excellent attention to detail and time management skills

Tools/Computer skills

• Medical Terminology Course, BSU

• Provider Electronic Solutions - claim submission

software that supports the following HIPAA

related transactions.

837 – Professional Claims

837 – Institutional Claims

837 – Dental Claims

270 – Eligibility Request transactions

271 – Eligibility Response transactions

NCPDP – Pharmacy Claims

NCPDP – Pharmacy Claim Reversals

Q&A Tool – SharePoint application used for

tracking questions submitted by the customer and

internal support staff.

Microsoft Communicator – Interactive instant

messaging application

ESS/Tempus Carta – Time tracking tool used for

logging time worked.

Microsoft Office Suite

Training

• Business Problem Solving: Critical Thinking and

Information Analysis

• Requirement Determination Process

• Communicating Effectively with Difficult Coworkers

Simulation

• Foundations of Grammar

Education

1989.1993 R.O. School Center, High School Diploma

Velika Kladu a, Bosnia and Herzegovina

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