Customer Service Medical
Resume:
GLORIA HILL
• Fort Benning, GA • *********@*******.*** •
QUALIFICATIONS SUMMARY
Highly personable Customer Service Professional with over ten years of experience in account
management claims processing, and call-center operations within the state medical benefits, major
medical insurance, and the telecommunications industries.
Talent for identifying customer needs and presenting appropriate company product and
service offerings.
Ability to gain customer trust and provide exceptional follow-up, leading to increased repeat
confidence in our current clients or recipients.
Expert in customer care/communications, problem solving, relationship building and user
training and support.
Implemented customer advocacy procedures that reduced customer complaints and improve
customer-satisfaction ratings.
Expertise in resolving escalated customer service issues.
Secured numerous company achievement awards for delivery of exceptional customer
service.
Proficient with Microsoft Office System (including Microsoft Word, Microsoft Excel, Microsoft
PowerPoint®, Microsoft Access, and Microsoft Outlook®).
Obtained one of the highest quality and call coaching scores in my unit
PROFESSIONAL EXPERIENCE
COLUMBUS REGIONAL MEDICAL CENTER
Registrar-Patient Registration (2010 to present)
• Interview patients to obtain all necessary account information
• Ensure charts are completed and accurate
• Verify all insurance and obtain precertification/authorization
• Calculate and collect patient liable amounts
• Ensure that all necessary signatures are obtained for treatments
• Answer any questions and explains policies clearly
• Process patient charts according to paperwork flow needs and established productivity standards
• Welcome patient and family members in a professional manner. Contact the nursing staff for
emergency medical needs and answer patient and visitor questions.
• Interview incoming patients, his/her relatives, or other responsible individuals to obtain identifying and
biographical information with insurance and financial information
• Assign I-plans accurately and research Patient Visit History to comply with the Medicare 72 hour rule
• Search MPI completely and assign the correct medical code number. Notify Medical Records for any
duplicate unit numbers.
…Continued…
GLORIA HILL
Page 2 of 2
Professional Experience Continued
• Verify insurance benefits and determines pre-certification status. If pre-certification is needed, call the
insurance utilization management department and initiate review or verify authorization number provided by
scheduling staff. Enter all information and authorization numbers into the registration system.
• Secure all signatures necessary for treatments, release of medical information, and assignment of insurance benefits,
and payment of services from legally responsible parties. Obtain copies of necessary
identification and insurance cards.
• Explain policies regarding services, charges, insurance billing, and payment of account. Request full
or partial payment for services rendered according to collection policies. Issue a Business Office letter
to all patients according to policy.
• Obtain proper authorization for treatment and approval codes from the insurance carrier for patients
presenting for treatment insured by an MCO. Collect co-pays, deposits, and deductibles and documents
collection status in the system and chart and issue waivers for signatures when appropriate.
• Inform former patients or their representatives of delinquent accounts and attempt to obtain payment.
Refer delinquent accounts to the Manager/Supervisor for further action.
• Receive and receipt payments from patient for services rendered. Prepare daily deposits and maintains
the integrity of the cash drawer.
• Produce paperwork on each patient for distribution to appropriate departments. Align pertinent
documents for establishing the patient’s medical record and financial file.
• Register and admit all patients after the other registration departments are closed. Route admission
documents and forms to appropriate departments.
• Price, key, and detail patient charges. Burst charts for distribution to physician’s billing service,
medical records, ancillary departments, and the business office. Check for double charges on all accounts.
BLUE CROSS AND BLUE SHIELD OF GA - Columbus, GA
Customer Care Representative III (2007 to 2010)
Served as Customer Care Representative for a major medical insurance company
I was promoted to a Customer Care Representative III within one year of being employed with the
company. I often collaborate with the Customer Care Manager and lead workers to create
strategic plans to enhance customer satisfaction. Assist my co-workers with the tools and training
to maintain and increase service levels to both internal and external customers. Work closely with
my lead worker to clarify information, analyze daily/weekly/monthly service statistics. On multiple
occasions I work as the acting operations expert in the absence of my lead worker. Selected as
the team captain to implement a new pilot program for the customer care advocates
• I contribute to increasing customer advocacy by 90% by assisting in execution of aggressive
advocacy plans on a daily basis
• Instrumental in improving customer-satisfaction ratings through suggestion, development, and
implementation of new reporting procedures
• Increased employee knowledge by assisting with development and implementation of product and
benefit awareness
• Enhanced my co-workers performance and attendance through daily mentoring, one-on-one
discussions and motivational strategies.
• Received outstanding positive comments from team members on employee reviews, as well as
exceptional feedback from senior management.
• Selected to coach and mentor new customer service representatives and conducted the technical
training for newly hired representatives
• Closely monitor and coach the new hires on a daily basis and assist them on the phones with the
clients
• Manually process and key medical claims
• Send written correspondence by electronic mail, fax, or mail responding to customer’s complaints
or concerns in a timely manner
• Selected as the team captain to implement a new pilot program for the customer care advocates
• I have the ability to properly tailor assistance to customers' based on their needs and concerns
• I am able to establish and maintain customer relationships by building the trust and
respect by consistently meeting and exceeding their expectations
WASHINGTON STATE MEDICAID - Lacey, WA
Medical Assistant III (2005- 2007)
As Customer Advocate, handled claims processing for the State of Washington and resolved customer
concerns in collaboration with respective agency and other departments. I was selected to prepare written
responses and inquiries to the Department of Insurance for potential medical professionals. Provided
measurement on volume and trends to determine agency education needs and improve customer
satisfaction and retention.
Served as a medical assistant for the department of Medicaid
• Processed medical professional and facility claims for all Medicaid recipients.
• Processed average approximately 400-450 facility claims per day and 600 professional claims per
day
• Completed corrections of claims in the Medicaid information system
• Processed Medicaid license number for new provider contracts
• Handled individual medical cases for potential recipients such for medical and food services
• Assisted with the development of the new plan for the new federal citizenship laws for recipients.
• Participated in implementing new paperless process, resulting in streamlined operations.
• Dramatically enhanced customer-satisfaction ratings by expediting all claims and ensuring a high
degree of accuracy
• Process the new medical professionals credentials and performed background checks before
assigning a Medicaid tax identification number
GLORIA HILL
Page 4 of 2
Professional Experience Continued
• Responded to all written correspondence received
BELLSOUTH TELECOMMUNICATIONS
Customer Service Representative (2002 to 2005)
Assisted the Training Manager in creating and updating training materials and prepared weekly reports for
the Customer Care Supervisor.
• Selected to coach and mentor new customer service representatives for opening of new call
center for AT&T.
• Achieved perfect score on all phone monitors throughout tenure.
• Received Customer Service Award for outstanding track record of positive customer feedback.
• Handled over 900-1200 calls per day
• Played key role in reducing staff scheduling changes.
• Received numerous accolades from senior management for consistently providing excellent
service and tactfully resolving sensitive issues.
PROFESSIONAL PREPARATION
• Currently enrolled at Everest University majoring in Medical Billing and Insurance
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