Customer Service Medical

Holly Lynn Walters (Pietrzak)

*** ****** ***, *******, ** 89408

Email: ***********@***.***

Cell: 775-***-****

Professional Profile:

Dependable and efficient individual with strong professional

work ethics, open to suggestions, changes and willing to learn

new concepts. Ability to work as a team member in a rapidly

changing environment with excellent public relations and

customer service skill and mature problem solving capabilities

with sound judgment.

Summary of Qualifications:

General Business Office & Management

. Experienced with a variety of computer software programs -

WP, Medical Manager, Mega West, Excel I,II,III, Word I, II,

Therapist Helper, Facets, Zurich-Easy Access, Outlook

. Business Letter Composition, Business Math, Business

English

. Mail Processing (mail meter-UPS, Fed Ex)/Multi-line

Telephone techniques (Avaya system)/Inquiry tracking

systems

. Copying / Collating / Image Archive Systems

. Filing: Alphabetic, Subject, Numeric, Geographic

. Data Entry - Typing & 10 key

. Scheduling (develop and maintain), Medical records,

Insurance verification

. Organize work areas to maximize efficiency.

. Provider credentialing.

. Maintain office equipment - Contracts with outside vendors.

. Accounts Receivable / Accounts Payable

. ICD-9 / CPT coding

. Medical billing, Collections, Pre-authorizations, Referrals

. Third party claims, Liens, Probates

. Refund reports / Aging reports / Billing reconciliation

. Knowledge of Cobra regulations, coverage.

. Group Health Plan Pre-existing calculations/coverage/credit

Workers Compensation Specific Experience

. Complete Claims file set up

. Policy & Coverage verification, specified protocols and

special handling noted.

. Investigate, evaluate & adjust medical only claims Tier

1 - Tier 3

. Effective and timely communication with clients,

claimants & other appropriate parties. *Recorded

statements.

. Establish reserves; provide reserve recommendations

within established authority levels.

. Review / approve related medical & legal on designated

claims.

. Referrals- legal, surveillance, case management, etc.

. Review, process claims billing and bill denials

. Summarize all correspondence & medical records into

claim log notes.

. Review & maintain personal diary on claim system.

. Maintain compliance with corporate claims standards and

special client handling instructions as established.

. Special projects - TIN reports, Escheat reports, DCI

reports, Zurich Claims tracking/billing, Legal

/Compliance tracking.

Employment History:

State Insurance Fund Boise, ID 208-***-****

Claims Examiner 02/09 - 5/10

CCMSI Reno, NV 775-***-****

Claims Associate 07/07 - 11/08

Blue Cross of Idaho Boise, ID 208-***-****

Claims Adjuster 12/06 - 07/07

CCMSI Reno, NV 775-***-****

Claims Associate 07/06 - 12/06

Blue Cross of Idaho Boise, ID 208-***-****

Enrollment & Billing Auditor 11/03-07/06

Meridian Psychological Center Boise, ID 208-***-****

Office Manager 07/01-11/03

St. Alphonsus Physician Serv. Boise, ID 208-***-****

Site Coordinator, AR/AP 04/99-07-01

Idaho Physical Medicine Boise, ID 208-***-****

Credit/Collections/AR 04/97-03/99

Fireman's Fund Insurance Boise, ID

Claims / Clerical 08/95-04/97

Ind. Insurance Sys. Of Nevada Carson City, NV

Medical Secretary, file clerk

Clerical Trainee 12/92-04/95

Education:

CCMSI Reno, NV

Work Comp 101

CCMSI Corporate Claims Best Practices

Zurich Best Practices / Protocols

Internal training - Work Comp Over view

Compensability - Course and Scope

Nurse Case Manger - Role and duties

TTD - PPD AMA Guidelines

Misc. internal training classes with outside

vendors presenting services available.

Blue Cross Internal Training Boise, ID

Code of Conduct

Fraud Awareness

Respectful Workplace

Customers First

Phone Pro

Accountability / Handling Conflict

HIPAA

Executrain Boise, ID

Excel I, II, III / Word I, II

Healthcare Cash Management Seminars, Inc.

*Insurance, Collections and Office Management Course

Idaho Medical Association & Brown Consulting Associates

*Coding Competency Workshop Series

*Coding Practicum for Experienced Coders

Boise State University Boise, ID

Outreach Programs / Medical Terminology

Western Nevada Community College Carson City, NV

Clerical Skills Program

Career College Of Northern Nevada Reno, NV

Word Processing / Office Procedures

References available upon request.

Reference Listing

Nancy Hopper Boise, ID 208-***-**** wk

Technical Advisor /Supervisor 208-949-4501cell

Tonee West Reno, NV 406-***-**** wk

Business Associate, Sr. Claims Mngr. 775-750-

6139cell

Susan Kissler Reno, NV 775-***-****

Business Associate

Marjorie Case Boise, ID 208-***-**** cell

Business Associate

Contact this candidate