Customer Service Medical

Confidential User

Email: abqrpz@r.postjobfree.com

Address: Address Withheld

City: Wyomissing

State: PA

Zip: 19610

Country: USA

Phone: 610-***-****

Skill Level: Experienced

Salary Range: $45,000

Willing to Relocate

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

855 N Park Road R204

Wyomissing, PA 19610

Cell (610/780-7944)

abqrpz@r.postjobfree.com

OBJECTIVE

To obtain a challenging position that is rewarding and provides room for advancement, in a forward moving company that is well established.

EMPLOYMENT

Refund/Recovery Specialist (2000-present)

The Loomis Company Wyomissing,PA

Duties and responsibilities include receiving refunds and returned checks on claims that are overpaid for Third Party, Self Funded Clients. A claims file audit and history review is required to determine the actual claim that is overpaid and the specific reason for the overpayment. The claim is then audited & adjusted by the amount of the overpayment. When this process is completed the funds are then allocated to proper client/group account.

The reason for the refund is documented for internal quality control purposes and for the client/group reconciliation reports. Any questions from the accounting department or client funding department are also handled.

This position requires knowledge of the AS400 system, Genelco system, Microsoft Office products, Excel, claims processing, medical CPT codes, ICD9 codes, & medical terminology. A math background and an understanding of accounting are also required. Basic knowledge of Stop Loss, Subrogation, Workman`s Compensation, Third Party Liability, and Coordination of Benefits is also necessary.

Professional written and verbal skills are required to communicate information to not only the claims adjustor, but also the client and the providers in order to provide clear explanations as to how the claim should be reprocessed and the specific reason for the refund and the affect on the claims history and the funding report.

Claims Adjustor (1999-2000)

The Loomis Company Wyomissing, PA

Responsibilities included claims processing and customer service for both medical and dental claims submissions. Knowledge of individual group policy benefits was required in order to properly process claims according to specific plan guidelines.

The ability to determine order of benefits to properly coordinate with primary, secondary, or tertiary plans was essential, as was determining if charges were motor vehicle insurance, workman`s compensation, or other third party liability was involved prior to issuing plan benefits.

Customer service responsibilities included answering calls to providers of service or to the insured regarding plan benefits, pre certification of specific procedures, and explanations as to the payment or denial of a claim.

Claims Adjustor (1993-1996)

U.S Life Corporation Reading, PA

American General (1996-1999)

After six months of extensive claims processing training, customer service, and medical terminology training was completed, assignment was given to specific states/groups for Indemnity Group Plans. Claims were reviewed and processed according to plan benefits and state guidelines and laws. Incoming calls were handled by the Customer Service department.

U.S. Life Corporation was sold to American General in 1996.

Medical Secretary/Receptionist (1987-1993)

John G. Meharg Jr., M.D. & George A. Jenckes,III, M.D. Shillington, PA

As a Medical Secretary/Receptionist duties included answering calls and documenting the calls into patient`s medical file/chart regarding symptoms, prescriptions, etc. Also scheduled appointments for outside diagnostic testing, referrals to specialists, OR scheduling, and calls to pharmacies to fill prescriptions.

Updated patient informational documents, scheduling of drug representatives appointments to meet with both doctors regarding new drugs and the information related to that drug along with keeping the inventory of drug samples and which patient`s they would benefit.

Accounts receivable and payable were done on a daily basis, entering patient payments, various types of insurance payments, making insurance carrier adjustments (i.e. Medicare, BC/BS, HMO`s & PPO allowables/discounts/write-offs).

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