Customer Service Medical

Michael Meade

**** ********* *** - *********, ** 40509

abiwlj@r.postjobfree.com - 859-***-****

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Objective:

To obtain a position that will utilize my skills and provide me with the

opportunity for professional development.

Experience:

The Pure Air Store

Customer Service:

2009 - Present Customer Service

Make phone calls to potential clients.

Schedule salesmen appointments.

Promote sales of products.

Order office supplies.

UMR/Fiserv Health - Legal Dept.

Compliance Specialist:

2006 - 2009 UMR/Fiserv Health - Legal Department

Develops, initiates, maintains, and revises policies and procedures for the

general operation of the Compliance Program and its related activities to

prevent illegal, unethical, or improper conduct.

Collaborates with other departments (e.g., Claims, Customer Service,

Provider Relations, Eligibility, etc.) to direct compliance issues to

appropriate existing channels for investigation and resolution. Consults

with the Corporate attorney as needed to resolve difficult legal compliance

issues.

Identifies potential areas of compliance vulnerability and risk;

develops/implements corrective action plans for resolution of problematic

issues, and provides general guidance on how to avoid or deal with similar

situations in the future.

Provides reports on a regular basis, and as directed or requested, to keep

the Compliance Committee and senior management informed of the operation

and progress of compliance efforts.

Monitors the performance of the Compliance Program and relates activities

on a continuing basis, taking appropriate steps to improve its

effectiveness.

Appeals Specialist:

2004 - 2006 UMR/Fiserv Health - Legal Department

Reviews all information submitted both pre and post adverse benefit

determination for Appeals committee.

Documents all actions in a clear concise manner.

Identify whether the case requires review by the independent physician

consultant.

Maintains accurate records of cause / origin and disposition of appeals.

Requests submission of additional information to clarify issues as

necessary.

Communicates with Claimants, their Representatives, and Physicians in a

professional manner.

Responsible for complying with all federal and state regulations including

ERISA and HIPPA.

Responsible for complying to internal appeals guidelines.

Participate in bi monthly team meetings and inter-departmental meetings.

Commonwealth Administrators.

Claims/CSR:

2003 - 2004 UMR/Fiserv Health - Claims/Customer Service Department

Processing of claims 90 to 120 claims daily while maintaining 95% accuracy

and achieving productivity goals and research provider billing issues,

Respond to 80 to 100 phone calls from providers and members answering

benefit questions and explaining claim payments.

Document all inquiry information as required guidelines to ensure proper

records are maintained for auditing purposes.

Respond to calls from providers and members answering benefit questions and

explaining claim payments

Inputting a wide variety of medical claims including physical therapies,

ENT, primary care and psychiatry visits, dental, eye/vision, surgeries,

diagnostic testing, ER and pharmacy.

Michael Meade

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Bluegrass Family Health.

Applications Analyst:

Maintain provider database and fee schedules in the Diamond system.

Report generation for various departments as warranted.

Generate membership cards on a daily basis for new members and reissue.

Problem determination and resolution within the application system.

Medical Claims Processor:

Utilize Diamond system to enter and maintain medical claims.

Process and pay PCP and all specialist claims.

Maintain a follow-up system to ensure any claims on hold are completed.

Desktop Publisher:

Design and layout of handbooks, manuals, newsletters, directories, flyers,

marketing materials and other publications.

Determine most attractive and cost effective style of printing and which

printing company would be best for outsourcing projects.

Monitor printing quotes and invoices in conjunction with accounts payable.

Design and coordinate graphic elements, photos, charts, overheads for

various projects.

Anthem Blue Cross Blue Shield.

Provider Inquiry Associate:

Apply computer network to access HMO of Kentucky and Blue Cross and Blue

Shield claims for processing.

Document all inquiry information as required by processing guidelines to

ensure proper records are maintained for auditing purposes.

Maintain a follow-up system to ensure any pending inquires are completed.

Complete any requested work, enter reports and/or daily operating reports

AmeriCorps/AASSP.

Computer Specialist:

Supervise and maintain computer systems for five counties.

Draft training manuals for operators.

Teach classes on computer/internet use to multiple operators.

Education:

Bluegrass Community College (Mayo Campus).

Major: Computer Information Systems - Degree Awarded.

AS/400 Programming.

General Accounting.

Bluegrass Community College (Prestonsburg Campus).

Major: Information Technology - Degree Awarded.

Desktop Publishing, layout and design.

Word Processing.

Skills:

Hardware: IBM AS/400, System/36, Desktop Computers.

Programming Languages: RPG, COBOL, Basic, Pascal, Fortran.

Software: Microsoft Office Suite, Adobe PageMaker, Illustrator, Photoshop,

Web Design Software, and DBASE.

Contact this candidate