Customer Service Quality Control
Resume:
Raheem Lamidi
Rolesville, NC *****
Email: abmorm@r.postjobfree.com
Administrative Assistant and Customer Care Specialist
Detail oriented and quality focused professional trained in medical
administrative support and recruiting capabilities for staff . Equipped
with excellent communication skills. Ability to analyze data, perform
multiple tasks and work independently. Can develop and maintain
professional, service-oriented working relationships with patients,
physicians, co-workers and supervisors. Able to understand and comply with
policies and procedures. Successful track record of handling complicated
assignments and administrative/clerical requests. Offer solid foundation in
software applications, database management, and data entry; proven ability
to readily master new technology. Dedicated to maintaining strict patient
confidentiality.
Relevant Experience & Accomplishments:
Administrative Skills
. Experience with ICD-9, CPT-10, MS Word and MS Excel.
. Well versed in the following: Medical Terminology, Medical
Insurance, Online Claim Submission, Medical Software, Keyboarding,
Medical Billing, Internet, Confidentiality.
. Recruit, train and supervise required staff in the
administration department
Serves as first line of support for customers.
. Manage human resources, payroll and accounts payable
functions
. Have strong five years experience as QA specialist
. Able to create and manage QA activities.
. In-depth knowledge of quality control / assurance.
. Excellent in communication and presentation skill.
. Good in computer knowledge
Customer Service
. Comfortable with computers, using phones, consulting with
clients and assisting their needs.
. Highly experienced with Customer Service and Technical Support
over the phone and through emails.
. Able to type 40-50 words per minute.
. Great math, analytical, and problem solving skills.
. Experienced with billing, payment processing, quality control,
trouble shooting, and general customer service inquiries.
. Technologies and Application Software:TestDirector 7.0i, Bug
Collector 4.0, FrontPage, CorelDraw etc.
. Modeling Solution: Rational Rose Enterprise
. Programming Languages: Java, PL SQL, HTML, Perl
Employment History:
Recruiter,Quality Control Specialist, Rti International
Contact info..Supervisor- Dan Rathers 919-***-****
September 2006-Current Job
. Analyze insurance coverage and benefits for service to ensure
timely reimbursement. Obtain all PAC and/or authorizations as
appropriate.
. Call patients to remind them to bring balances due, co-pays, co
insurance and deductible.
. Setting budgets and/or agreeing them with senior management
. Responding to customer complaints.
. Helping members Find The Best Plan For Them In A Respectful manner
. Resolve insurance claim rejections/denials and remedy expediently.
. Coordinates audits of patient accounts for all customers including
external and internal audits. Appeals insurance denials and gathers the
necessary financial and clinical data to work directly with the insurance
representatives. Responds to customer inquiries, telephone and
correspondence.
. Explaining billing to patients according to credit and collection
policies, when discussing insurance with patients.
. Determining necessity of third party sponsorship and processing
patients per policy and procedure. Examine insurance policies and other
third party sponsorship materials for sources of payment
. Dealing With Pharmacy Claims And Medical Billing With Customers.
. Coding, DRG assignment, collection of predefined indicators and
abstracting medical records. Provide timely and accurate ICD-9-CM and CPT
codes for reimbursement and specific information for statistical
purposes.
. Abstracting and data entry of coding information and other
statistical data from medical record; review of medical record for
appropriate outpatient diagnostic orders and abstracts information for
use by The Accounting department to ensure appropriateness of billing.
. Perform duties necessary to ensure all accounts are processed
accurately and efficiently. Promote and maintain excellence in customer
service
. Recruit, train and supervise required staff in the administration
department
Serves as first line of support for customers.
. Created, managed, organized and direct all Quality Assurance (QA)
activities for type and production documentation programs.
. Played key role in the creation of an proficient and efficient system
for ensuring the quality of product
. Helped other departments to create compliance information packages.
Secretary And Recruiter, Board of Elections
Contact info...Gina Lucas 919-***-****
June 2005---January 2008
. Responsible for ballads development and monitoring of assigned
departments
. Ensure that policies & procedures and applicable laws are adhered to
at all times
. Manage human resources, payroll and accounts payable functions
. Recruit, train and supervise required staff in the administration
department
. Serves as first line of support for customers.
. Scheduled Appointments For Visitors To Meet Mayor
. Maintains accurate and complete scheduling database.
. Obtains or verifies complete visitors demographic information from
Visitors
. Adjusts, rearranges, and schedules daily procedure schedule according
to block scheduling guidelines and policy to obtain the greatest
efficiency and optimal use of OR space and associated resources.
. Provides printed and faxed schedules to designated recipients
EDUCATION
Wakefield High School
Graduate.2008
G.P.A 3.4
CERTIFIED
Pharmacy Claims Specialists
Humana
Registered Health Information Technician
Humana
Certified Data Abstracter
Coder
Humana
Data Collection Specialist
Humana
Contact this candidate