Customer Service Manager
Resume:
Karen Leedom **** Westridge Dr . Oceanside, CA ***56 . 760/207-9826
QUALIFICATIONS
HIGHLY QUALIFIED HEALTH INSURANCE SPECIALIST with strong record of
performance-based promotions. Demonstrated ability in fast paced/high
volume environment. Very analytical with exceptionally good investigational
skills; quickly discern discrepancies. Extensive experience in:
Supervising staff; updating personnel on new procedures. Medical
claims processing. Medical claims billing and collections. EDI
processing, HIPAA guidelines, ICD9 coding.
Strong customer relations skills, recognized for ability to resolve
problems and maintain client retention. Adept at communicating with insured
clients, medical professionals, and insurance providers. Committed to
company goals; consistent "overgoal" performance. Team player. Excellent
organizational and time management skills.
EMPLOYMENT
EA Health Corporation
2007-Present
Accounts Receivable Specialist
Responsible for accurately submitting anesthesia claims according to
payer specific guidelines. Review Medicaid claims /correct coding
errors prior to submission. Review and correct certain coding denials.
ICD9 coding for GME/DIB doctors. Responsible for all coding changes
in billing system received from coders. Monitor all claim errors in
billing system to include billing, enrollment and coding department/
report to Billing Operations Manager any patterns detected or untimely
corrections.
The Plan Handlers, Inc.
2002-2007
Claims Analyst/Trainer-Auditor/ Technical Support Supervisor/Assistant
Claims Manager
Performed overall medical claim processing ~ Promoted to
Trainer/Auditor; Trained new hires for Claim Department and Customer
Service. Audit large dollar claims for accuracy of payment. Ongoing
training with audit results ~Promoted to Supervisor of Technical
Support Department to include the filing, collecting and posting of
Reinsurance claims, prepare disclosures and update reports for Client
Services Director ~ Promoted to Assistant Manager. Managed the
Claims/Customer Service Department, concentrating on excellent
customer service and reduction of backlog. Managing onsite office of
25 employees and offsite office of 8 employees.
Providence Systems, Inc. 2000-2002
Marketing Representative
Responsible for marketing events for Real Estate seminars. Daily
contact with professionals in the Real Estate, Lending, Insurance, and
other fields who could benefit from Referral business.
The Plan Handlers, Inc. 1999-2000
Claims Analyst
Performed medical claim processing for several self-funded groups.
Provided daily customer service to
insured clients and medical providers.
Primary Care Associates 1997-1999
Claims Auditor
Ran daily reports of claims processed and reviewed for accuracy of
payment. Provided ongoing training in areas of concern. Reviewed and
resolved member/provider complaints. Daily contact with insurance
companies for claim payment resolution in an IPA setting.
Pro-Intermed 1995-1997
Medical Insurance Representative
Provided billing and collection of HMO and PPO claims to various
clients. Performed daily contact with Insurance companies to determine
claim payments, accuracy of payment and investigate non-payment of
claims.
The Principal Financial Group 1985-1995
Claim Examiner, Training Supervisor, Claim Supervisor, Account
Representative
Performed overall medical/dental claim processing. Trained new staff
on claim processing fundamentals; worked with Home Office to set up
new claim paying system/training. Resolved member/provider complaints.
Provided quotes and marketing material to potential clients in Sales
Office environment. Daily contact with
Brokers/Clients during implementation of group set up. Ongoing
communication to insure client retention.
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