Customer Service Manager
Resume:
Corri Borges
Des Moines, WA *8198
Email ***********@*****.***
Management/IT Skills-
. EPIC certified in Insurance Claims follow up, Payment Posting, SBO and
proficient in Charge entry
. EPIC trainer for 6 years on Resolute and Prelude. Responsible for
upgrade and new employee training and training materials.
. System Administrator for multiple insurance websites and password
applications
. Constructive operational problem solving and communication at all
levels
. Assisted in implementation of Epic, Electronic Eligibility System, and
maintenance of Account, Credit Balance, and Follow up WQ's
. Development and oversight of well-trained, highly competent clinic
staff
. Effective implementation and evaluation of departmental practices,
policies, and continuous process improvement
. Experience in Registration, Scheduling, Authorizations, Payment
Posting and Claims
. Call Center Supervisor
. Ability to work effectively both independently and as a team player
. Problem solve computer issues within the Epic/Resolute system
. Decreased both duplicate denials and eligibility denials by 50%
. Attend provider meetings with provider representatives and contracting
department to address individual provider/payer issues that affect
claims and payment posting
. Create rules and priorities for work queues. Build account work
queues and claim edit rules within Epic/Resolute
. Experience in interviewing, hiring practices, and training of staff
Office Skills-
. Proficient in Microsoft office, Windows, Medisoft, Medware, Qmacs,
Milliman and McRoberts, Lotus, Access, Word Perfect, Last Word,
Passport, Epic/Resolute, Misys, Cognos, and MPV
. Excels in time management and organization skills with the ability to
effectively deal with patient needs as well as focusing on the needs
of the organization
. Aptitude to write monthly status reports, excel databases, and closing
case summaries
. Working knowledge of medical billing including Medicaid, Medicare and
commercial, payment posting/accounting, and collection
policies/procedures.
Education-
2002-Current Masters in Health Care Administration Canyon
College
1999-2001 Bachelors in Social Science
Washington State University
1997-1998 AA in Medical Assisting
Lower Columbia College
1994-1996 AA in Social Science
Lower Columbia College
Work Experience
Valley Medical Center-Billing Manager Renton, WA 03/01/2010-current
. Manage payment posting, collections, A/R, refunds, and customer
service department daily tasks
. Responsible for patient services and payment posting departments
including monitoring staff, handling of patient accounts, follow-up
on complaints, work queue status, collections, and billing commercial,
Medicare, Medicaid insurance
. Responsible for interviews, evaluations, weekly phone schedule,
workload reports.
. Performs regular audits of staff productivity accounts to identify
training issues and monitors staff performance on a monthly basis
. Currently on EPIC project team for July 2012 implementation for
business office
Children's University Medical Group- Patient Accounts Manager Seattle,
WA 02/01/2004-03/01/2010
. Provide daily support for Claims Edit Specialists, Self Pay
Collectors, Claim Specialists, Payment posting, Credit Balance and
other assigned staff in Epic/Resolute.
. Responsible for patient services and payment posting departments
including monitoring staff, handling of patient accounts, follow-up
on complaints, work queue status, collections, and billing commercial,
Medicare, Medicaid insurance.
. Understand and follow privacy laws (HIPAA), and implementation and
maintenance of CUMG policies and procedures
. Provides managerial leadership for staff through effective performance
development, goal setting and supervision. Ensure that staff has
access to appropriate training and professional development.
. Work closely with IT Department on identification and resolution of
technical issues.
. Performs regular audits of staff productivity accounts to identify
training issues and monitors staff performance on a monthly basis.
. Primary EPIC trainer on all departments for new employees and upgrades
from 2004 to 2010
Seattle Radiologists-Scheduling Coordinator Seattle, WA
05/01/2003-02/01/2004
. Schedule patients for simple and complex radiology procedures
. Verify insurance coverage and obtain authorizations
. Daily contact with patients and doctors office providing excellent
customer service.
. Register patients
Molina Health Care-Authorization Specialist Bothell, WA
07/01/2001-05/01/2003
. Handle urgent requests for referrals/authorizations to specialists and
emergency care
. Call center environment working phones (40-80 calls per day)
. Team Leader when supervisor was out of the office
. Logging and processing appeals for both providers and members
. Responsible for claims and authorization adjustments/reprocessing
. Charge of correspondence and rate acceptance for non-participating
providers
. Trainer and team interviewer for new hires
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