Customer Service Representative

Kimberly L. Hoefer

PO Box ***** u Columbia, SC **224u 803-***-**** u ********@*****.***

Objective: I would like to obtain a position with an organization which not only utilize my existing skills,

but would provide me the opportunity to learn new skills which contribute to the future growth of your

company.

Skills Summary

HIMR( Health Insurance Artiva Microsoft Office

Master Record) Customer Service Data Entry/Numeric Data Entry

codes/CPT Medical Billing UB-04/ HCFA 1500

Medicaid/ Medicare Commerical HIPAA

Insurance Insurance HBO & Solcom

Claims Processing Typing Speed -45-50WPM

General Office Skills

Professional Experience

03/2009- PRESENT PALMETTO HEALTH COLUMBIA, SC

MEDICAID REPRESENTATIVE/MEDICAID AND TRICARE BILLER

Properly processes hospital billing information and updates patient insurance information

Prepare and file appropriate primary or secondary billing for Medicaid/ Tricare claims and patient statements.

Research accounts to verify charges, coding and procedures daily, forward to the appropriate department to verify

charges and obtain charge correction documentation.

Document all billing notes an patient telephone calls.

Monitor and audit accounts and process adjustment to accounts as necessary.

Transfer charges to secondary insurance for billing.

Respond to inquiries from patients and collection agencies, as needed.

03/2008-03/2009 PALMETTO GBA COLUMBIA, SC

MEMBER SERVICE REPRESENTATIVE

Ensures effective public relations by responding accurately, timely, and courteously to telephone and written inquiries

from customers from the Medicare Contract.

Assist Medicare Part A Providers and Home Health and Hospice Providers with billing and coding their claims for

correct processing to Medicare

Initiates re-opening or other research as needed to resolve customer inquiries.

Coordinates with other departments such as claims, medical review, professional reimbursement, overpayments, MSP,

and training department to resolve problems.

Research provider inquiries about appeals and other issues regarding claims processing.

Assist with training of new employees and the cross training of co-workers.

04/2007-04/2008 AETNA COLUMBIA, SC

DATA ENTRY OPERATOR/ REPRICER

Performs clerical duties and/or prepares for the claims department

Provide office support needed to ensure that business objectives are met

Reprice medical and dental claims to ensure proper payment according to the members contract guidelines.

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02/2006-03/2007 Blue Cross Blue Shield COLUMBIA, SC

MEMBER SERVICE REPRESENTATIVE

Handle incoming calls from members and attorneys about auto accidents and workers compensation claims

Assist adjusters with taking accident questionnaires over the phone to determine where to route the calls.

10/2004- 01/2006 BLUE CROSS BLUE SHIELD COLUMBIA, SC

CODER/KEYER

Screen and key health and dental claims.

Apply CPT and ICD-9 to ensure proper and accurate adjudication of claims and pull Medical Records from other

departments to assist with claims processing.

Assist management with special projects.

05/2003- 10/2004 BLUE CROSS BLUE SHIELD COLUMBIA, SC

MEMBER SERVICE REPRESENTATIVE

Handle incoming calls from small group and individual members.

Assist members with all claims including prompt and accurate processing of claims and adjustments.

Assist members with their prescription benefits and claims issues.

08/2001- 05/2003 BLUE CROSS BLUE SHIELD COLUMBIA, SC

MEMBER SERVICE REPRESENTATIVE

Handle incoming calls from retired military over the age of 65.

Identifies incorrectly processed claims and completes adjustment and processing actions according to department

guidelines.

Handle calls from providers with refunds, eligibility and claims issues.

Eucation:

2009- Present Limestone College Columbia, SC

Pursing a Bachelor’s in Human Resource Management

2006

Citizen High School

-Diploma

1994-1998

Eau Claire High School

References: Available Upon Request

Contact this candidate