Customer Service Medical

Enid Mercado

**** **** ******** ****** **** #*, Vineland, New Jersey 08361

Tel: 856-***-****

************@*****.***

Personal Statement

I am a highly motivated, responsible, hardworking, conscientious individual with extensive experience performing general office procedures. Known for my excellent customer service and organization skills. Proven ability to meet deadlines on time sensitive matters that require haste responses. I am a true team player and I will go above and beyond what is expected of me to help others without hesitation.

Objective Statement

Obtain a position as an administrative assistant in which my organizational abilities can be fully utilized. Work in a place where there is a need for a variety of office management skills including – computer knowledge, organizational abilities, business intelligence and database program use.

Work Experience

Supervisor of medical claims for auto carrier

New Jersey Manufacturers Insurance Company, West Trenton, New Jersey 09/2000-06/2012

Customer service; returned voicemail and answered high volume telephone calls in the absence of my employees, handled attorney calls, customer complaint calls

Administrative duties; type form letters to insured, claimants, attorneys and providers; proofread letters for my employees prior to mailing.

Completed yearly performance appraisals for 6 employees,

Set goals for each employee.

Monthly metrics system on each of my employees for their work production.

Audited claim files monthly as well as quality control of 2 audited phone calls monthly

PIP subrogation tasks with completed contentions for arbitration filed against us or against adverse carrier, adjudication of bill processing that includes the ICD 9 codes, procedural codes

Review of medical documentation to support the necessity and relatedness of the procedure being performed.

Decipher medical necessity for precertification requests of treatment plans which include and not limited to, chiropractic, physical therapy, diagnostic imaging or testing or any medical treatment being requested.

Monitor and document the job performance on monthly or quarterly basis for each of my employees.

Handled Administrative duties such as scheduling and conducting monthly department meetings with agenda topics to be discussed in the absence of the department manager.

Conducted training sessions within the department on new procedural changes and updates that were being

enhanced to the computer system.

PIP No-Fault Claims Adjuster

Ohio Casualty Insurance Company, Mt. Laurel, New Jersey 09/1994-08/2000

Customer service; handled high volume telephone; returned voicemail to customers and answered external and internal calls.

Handled 350-400 medical PIP claims that included the claims coverage, settling PIP suits;adjudication of high volume medical bill processing.

Handled medical claims for New Jersey, Delaware, Connecticut, New York, and Pennsylvania.

Review of medical documentation, diagnosis, prognosis for provider bills

Settling of PIP Subrogation

Administrative duties;typing form letters to insured, claimants, attorneys and providers

Education

Diploma Vineland Senior High School, Vineland, New Jersey

Certifications

3/7/2013 Certified Medical and Coding Specialists/ Certified Medical Administrative Assistant/Electronic Health Records from Medical Consultants Instructional Training Center (MCITC)

Skills

MS Office 2010: Word, Excel; WordPerfect

Guide-wire 2008 Claims Center Paperless system

Bi-lingual - Fluent in Spanish (read & write)

Medical billing

Medical coding

Electronic Medical Records

Achievements

06/2003 Certificate of completion for Supervisory Management-18

Essentials of Supervision

New Jersey Manufacturers Insurance Company

06/2004 Certificate of completion for Supervisory Management -19

Supervisory Skills

New Jersey Manufacturers Insurance Company

02/2007 Certificate of completion for Training the Trainer

New Jersey Manufacturers Insurance Company

06/2011 Certificate of completion for Performance Management from Rutgers Training for Goals and Objectives supervisory classes

New Jersey Manufacturers Insurance Company

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