Customer Service Office
Resume:
Shalon Dudley
Pittsburgh, PA ***19
Telephone 412-***-****
********@*****.***
SKILLS AND KNOWLEDGE
Microsoft Office Suite Medical Terminology ICD-9 and CPT-4 Coding
QuickBooks Claims Adjudication Medisoft
UB-92 & HCFA-1500 Forms Care One Facets
Inbound/Outbound dialer Community Care Optum RX
CIS (DPW PA state system) CAPS (CHIP system) ICUE
ODM March Vision
EDUCATION
Median School of Allied Health Careers, Pittsburgh, PA November 2000
Health Claims Examiner/Medical Biller Diploma
YWCA, Pittsburgh, PA September 1999
Customer Service Certificate
EXPERIENCE
United Healthcare, Pittsburgh, PA Jan. 2017 - Apr. 2017
Member Services Advocate
Responded to and resolved on the first call, member service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence.
Educated and guided members about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider.
Intervened with care providers (doctor's offices) on behalf of the member to assist with appointment scheduling or connections with internal specialists for assistance when needed.
Assisted members in navigating myuhc.com and other UnitedHealth Group websites and encouraged and reassured them to become self-sufficient.
Resolved resolution on behalf of member in real time or through comprehensive and timely follow-up
Researched complex issues across multiple databases and worked with supported resources to resolve customer issues and/or partner with others to resolve escalated issues.
Provided member with the updated status on previously submitted pre-authorizations or pre-determination requests.
Responsible for meeting performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance.
United Healthcare, Pittsburgh, PA Oct. 2015 - Nov. 2016
Customer Service Associate
Contacted members to introduce individual healthcare plans.
Answered clarifying questions regarding healthcare plans.
Reviewed and completed HRA/REL/PHQ9 assessments per member in Community Care and Care One systems.
Transferred new member data HRA’s into excel spreadsheet.
Verified and updated members demographic information in Care One and Facets systems.
Schenley Heights Community Development Program, Pittsburgh, PA Dec. 2002 - Jan. 2014
HR & Office Manager
Created HR files, responsible for maintaining and documenting employee clearances, developing new hire offer letters, spreadsheets, workers comp, unemployment/social security documentation, maintain database of current and past employees and filing of other office documentation.
Supported the Executive Director and other Administrative staff.
Maintained the office operations, office information, organization calendar with program information, Inter-agency and other correspondence and also managed all mass mailings.
Established program fees with fiscal and Executive Director, invoicing of parent monthly payments, prepared and managed monies to be deposited into the bank account, payroll preparation and petty cash reconciliation.
Entered data in the county’s KIDS system.
Contacted local businesses for organizational purposes.
Occasionally directed incoming calls to appropriate department.
Finance Liaison (promoted)
Prepared and mailed out monthly invoices to parents.
Responsible for preparation of payroll.
Assisted financial administrator with reconciliation of organizational cash flow.
Processed accounts payable/receivable.
Office Manager (promoted)
Maintained the office operations in absence of Director of Operations.
Communicated regularly with organization stakeholders.
Supervised daily activities of employees.
Admin Assistant (promoted)
Developed written communication for various agencies, parents, and staff.
Answered telephone and directed incoming calls to appropriate department.
Ordered, organized, and operated office equipment along with program & office supplies.
(APS) Highmark Blue Cross/Blue Shield, Pittsburgh, PA June 2001 - Jan. 2002
Claims Processor (Temporary through Kelly Services)
Coded, voided, updated and adjusted provider maintenance, along with releasing claims to be paid.
Proofread and verified refund letters for correct payment to providers, patients, and insurance companies.
OSI, Pittsburgh, PA Feb. 2001 - June 2001
Insurance Follow-up Rep
A/R follow-up and physician billing for Cleveland Clinic.
Contacted Insurance Companies and verified patient claim information for rebilling and payment.
Dialysis Clinic, Inc., Pittsburgh, PA Sept. 2000 - Oct. 2000
Medical Billing Externship
Performed daily billing on Darwin System.
Manually updated payments to transaction logs.
Documented investigation of unpaid Blue Cross claims.
Balanced patient medication payments on spreadsheets.
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