Customer Service Representative
Resume:
Lydia Gotay
Pompano Beach FL 33069
Summary of Qualifications:
** ***** ** ********** ************** experience
** ***** ** ******** ******* experience
10 years of Health Management experience
10 years of Collection experience
Medical Billing experience
Excellent analytical, problem solving, organizational, and communication
skills
Bilingual
Experience:
Biller/Collector
Kindred Hospital
Ft Lauderdale, FL
June 2005 to March 2008
Verified insurance to obtain accurate patient billing information. Reviewed
all patient accounts for accuracy and completeness. Determined appropriate
billing distributions. Followed up on all patient accounts, resolved any
problems including claim corrections, appeals and special circumstances to
maintain an uninterrupted cash flow.
Medical Biller/Collect
Medical Biller/Collector Biller/Collector
November 2004 to June 2005 Phoenix Physicians
Oakland Park, FL
November 2004 to June 2005
Assured accuracy of patient data and prepared billing according to
regulations. Maintained billing records, providing timely insurance follow-
up and taking immediate action on issues that involve account integrity.
Monitored insurance coding and responded to all patient account inquiries.
Patient Accounts Representative
Boca Raton Community Hospital
Boca Raton, FL
March 2004 to August 2004
Responsibilities included reviewing claim denials focusing on trends,
whether it be claims correction or appeals. Communicating with all types of
insurance carriers including Medicare and Medicaid to expedite claim
processing and initiate appeals. Duties also included posting payments,
contractual adjustments, and setting up payment arrangements.
Collection Specialist
Watershed Addiction Center
Delray Beach, FL
March 2002 to December 2003
Accountable for all aspects of patient accounts from admission to
discharge. Duties included verifying medical benefits, guaranteeing correct
payment of claims according to these benefits. Reviewing UB92's and HCFA
1500's making corrections when necessary including authorizations.
Substantially increased collection revenues.
Follow-up Insurance Specialist
BCC Financial
Ft. Lauderdale, FL
September 1998 to December 2001
Responsible for all client functions. Extremely knowledgeable of all
required reporting including Medicare, Medicaid, Workers Compensation, PIP
and all other liabilities. Prepared appeals and settlement negotiations.
Health Management
Humana/PCA Health Plans
Miami, FL
Resolution Representative
September 1995 to July 1998
Resolved issues and complaints that could not be handled upon initial
contact by the general customer service representatives. Investigated,
documented, and followed through to completion complex member and provider
inquiries. Served as Broward County School Board employee liaison for
insurance marketing efforts. Interacted with physicians and hospitals
facilitating contractual agreements internally for total client
satisfaction.
Customer Service Representative
Blue Cross/Blue Shield of NY
March 1993 to July 1995
Recruited in 1993 as a customer service representative for Empire's NYC
dedicated service center. Duties included reviewing all correspondence
including medical records and responding to inquiries and adjudication of
claims. Subsequent to promotion, additional responsibilities included
personnel training and efficiency review of Tri-State area via monthly
management conferences.
Education:
Intercoast Business Education & Training
Certified Patient Account Technician
American Association of Healthcare Administrative Management
Hunter College
New York, NY
Software Knowledge:
Idx Idx Tiger Millennium McKesson HBO Star
AS400 Invision AS400 Medic Meditech
Doctor's Partner
Contact this candidate