Customer Service Medical
Resume:
CHRYSTINE L. LOPEZ
**** ******* **** ***** ? Rockford, Illinois 61114
719-***-**** ? abi0co@r.postjobfree.com
SUMMARY OF QUALIFICATIONS
. Analytical thinking, with excellent listening, verbal and written
communication skills.
. Able to quickly establish rapport and maintain relationships with
clients, co-workers and others.
. Strong organizational skills, detail oriented,
. Excellent prioritization, time management and multi-tasking skills.
Able to work efficiently without supervision.
. Highly skilled in identifying, evaluating and solving internal and
client relations workflow obstacles
. Flexible, with ability to work independently within a team to meet
goals, challenges and deadlines
. Knowledgeable in CPT-4, ICD-9, HCPC, REV, NDC Codes, medical
terminology, billing forms and review of medical records.
. Experienced in Work Comp Jurisdictional Rules & Regulations, Medical
Fee Schedules, UCR, Managed Care & PPO Contracts, Provider
negotiations, appeals for reconsideration, Third party Liability and
Subrogation and HIPAA compliance.
. Proficient computer skills, use of software applications and operating
multi-line telephone system.
PROFESSIONAL EXPERIENCE
IME SCHEDULER/CREDENTIALING ASSOCIATE
NMR/ELITE PHYSICIANS, ROCKFORD, IL
12/2008 - 3/2010
. IME Scheduler/Credentialing Associate
o Received referrals from multiple insurance clients requesting
Independent Medical Examinations for STD, LTD and MVA claims.
o Researched and located physician/health care specialist according
to client specifications to perform IME.
o Secured contract rates with provider, obtained professional
credentials information and maintained data base.
o Coordinated appointment date/time, prepare quote fees to client,
generated appointment information letters for claimants and
attorneys.
o Gathered, maintained and organized claimant file, medical records
and other information.
o Follow up with professional offices for timely and accurate final
reports, invoicing and payment.
BILL REVIEW TEAM LEAD
ZURICH NORTH AMERICA, COLORADO SPRINGS, COLORADO
11/2000 - 5/2006
. Started in the position of Commercial Claims Customer Service
Representative
o Accurately captured & documented vital first report claims
information for all commercial lines of business: Auto, General
Liability, Professional Liability, Property/Casualty and Workers
Compensation via phone, internet and paper claims.
o Researched claim information for adjusters, brokers, claimants and
clients
. Promoted to the position of Health Care Cost Specialist
o Initial participation in transfer of and establishing business unit
in new location
o Reviewed and processed medical bills according to the appropriate
National/State/Local Workers Compensation, medical fee
guidelines, UCR methodology and client instructions
o Verified accurate billing information including: Patient
information, CPT-4, ICD-9, HCPC, and NDC coding on HCFA1500 and
UB92 forms
. Promoted to the position of Bill Review Team Lead
o Reviewed, investigated and resolved provider claim
appeals/disputes.
o Established, nurtured, maintained and advanced client
relationships.
o Evaluated, revised & implemented workflows for business unit cost
benefits.
o Frequent client teleconference, face to face meetings and other
media venues to consult, professionally bond and exchange industry
information.
o Performed claim payment accuracy audits and maintained company
reports
o Actively participated in continuous team education regarding
industry changes and individual coaching needs.
THIRD PARTY LIABILITY SPECIALIST
PACIFICARE (FORMERLY FHP), COLORADO SPRINGS, COLORADO
10/1994 - 6/1997
. Started in the position of HMO Claims Processor
o Researched, calculated, and authorized payment of HMO and Medicare
Supplement claims
o Specialty Claims Processor for transplant recipients
o Communicated with providers to verify questionable billing
information
CHRYSTINE L. LOPEZ
5075 Burning Tree Drive ? Rockford, Illinois 61114
719-***-**** ? abi0co@r.postjobfree.com
PROFESSIONAL EXPERIENCE continued
. Promoted to the position of Third Party Liability Specialist
o Five state caseload for HMO, PPO and Indemnity third party and
subrogation claims.
o Point of contact for attorneys, providers, insurance companies and
claimants
o Investigated, negotiated and released claim settlements with third
parties.
o Generated letters stating and securing the company's interest for
claims paid.
o Worked with all departments and external contacts to close claims.
o Maintained records and prepared monthly reports on caseloads and
work progress.
WARD SECRETARY
DEKALB COUNTRY NURSING HOME, DEKALB, ILLINOIS
8/1989 - 7/1994
. Started in the position of Certified Nursing Assistant
o Performed pre-professional tasks.
o Assisted in the physical care of geriatric and long-term care
patients.
o Executed defined rehabilitative programs and care plan
documentation.
. Promoted to the position of Ward Secretary
o Prepared unit and work assignments for RNs, LPNs, and CNAs.
o Transcribed nursing and physician orders and maintained all medical
records.
o Scheduled diagnostic tests, maintained vital records, inventoried
and ordered prescriptions & supplies.
REFERENCES AND FURTHER DATA AVAILABLE ON REQUEST
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