Customer Service Insurance

WANDA M. RAY-CANADA

***** *********** *****, *** #**

Silver Spring, MD 20904

Phone: 301-***-****

Cell: 301-***-****

Email: ***********@*****.***

EDUCATION

****-**** ****** ****** ***** Technical Training Center - Pensacola, FL

Certificate of Completion - Cryptology: Non- Morse Code Interceptor

Graduated with Honors - Samuel B. Morse Award

1982-1984 Dekalb Community College - Decatur, Georgia

Course of Study - General Studies

1995-1996 Montgomery College - Rockville/Germantown, MD

Course of Study - Paralegal Studies

2007-Present American Intercontinental University (Online)

Course of Study - A.S. Business Administration- Medical Billing/Coding

EMPLOYMENT

2015-2016 AmerisourceBergen/Lashgroup – Rockville, MD

Sr. Reimbursement Counselor

Under the general supervision of the Reimbursement Supervisor/Manager, is responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.

Collects and reviews all patient insurance information needed to complete the billing, collections, appeal, and/or cash processes. Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payers. Researches and resolves any electronic claim denials. Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly. Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers. Independently analyzes, reports, and communicates any reimbursement trends/delays (e.g. billing denials, claim denials, pricing errors, payments, etc.).

Processes any necessary insurance/patient correspondence. Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians. Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process. Provides training and support to inter-departmental associates. Independently and effectively resolves advanced accounts with minimal supervision.

May travel to sites to present program services and further build relationship with sites. Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation. Communicates effectively to payers and/or claims clearinghouse to ensure accurate and timely electronically filed claims. May have responsibility for particular geographic regions, physician office sites. Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions. Networks with internal and external personnel in own area of expertise. Typically determines methods and procedures on new assignments. Performs related duties and special projects as assigned. mathematical skills. Strong analytical skills. Strong organizational skills; attention to detail. Proficient knowledge of accounting principles, pharmacy operations, and medical claims. Proficient knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding. Global understanding of commercial and government payers. Ability to proficiently use Microsoft Excel, Outlook and Word.

2013-2015 GW Medical Faculty Associates - Washington, DC

Sr. Call Center Specialist (RX/Referrals) - Medicine

Answer incoming calls in professional manner following department guidelines. Manages calls in a personal, systematic and organized manner. Route calls internally using appropriate call center guidelines. Perform all registration for new patients and updates registration information for established patients. Schedule various patient appointments, tests and procedures using a computerized scheduling system. Schedules, reschedules, cancels and verifies appointments. Prepares and mails appointment notices and patient information, as required. Provide patient instructions verbally or in writing in order for patient to prepare for appointment. Creates and generates task and directs to appropriate person based on content of message. Schedule requests sign language interpreter for patients when appropriate. Receives, relays, and processes information regarding appointment cancellations for Department of Medicine. Respond to customer inquiries. Identify and escalate priority issues. Provide general information to callers regarding the Department of Medicine.

Work with administrative assistants and other internal departments to efficiently and effectively resolve customer needs. Schedule appointments for advanced specialties and procedures, to include Cardiology testing and Endocrinology. Provides patient instructions verbally and in writing to patients to help prepare for appointment. Display in-depth knowledge of all necessary Medicine Specialty Divisions. Process request submitted by clinical staff and team members in appropriate Allscripts views. Ensure quality and safe delivery of health care services through accurate documentation. Able to research, analyze and schedule in first available view, schedule view and detail view of Touchworks. Has TST access and schedules TST appointments as directed. Schedule appointments for urgent care while following departmental guidelines. Assist with working administrative tasks generated by the providers under the supervision of the Management Team.

Ability to review chart documents to determine needs of patients. Assess computerized medication log and process medication request as needed. Knowledge of medication names and/or use and dosage amounts etc. Create and generate referrals for patients as required. Communicate with insurance companies by internet, fax and phone in order to process request. Knowledge of the prescription and referrals processes. ADD FUNCTIONS FOR RX AND REFERRAL TEAM. Displays exemplary phone etiquette, focuses on and able to provide exemplary customer service. Demonstrate excellent verbal and written communication skills. Possess the ability to perform at satisfactory levels in listening skills, and problem analysis. Work collaboratively with members and staff across service lines. Demonstrate an awareness and sensitivity towards patient/family rights. Comply with departmental standards regarding training, professional development, communication, management of workload, and safety/emergency situations. Perform job duties at satisfactory levels using Allscripts and all other office programs. Other duties as assigned.

2010 - 2011 Kaiser Permanente - Gaithersburg, MD

Receptionist – Obstetrics and Gynecology/Dermatology

Register members to include: verifying eligibility; updating demographic information; identifying FYI's and special appropriate assistance, and creating new accounts, as needed. Receives funds from members, completes receipts and properly posts transactions. Retrieves, reconciles, and deposits change fund. Schedule all patient appointments at the request of members and providers in accordance with established protocol. Inform member of date(s) and gives appropriate pre-appointment instructions, as necessary. Receives and screens telephone calls, if necessary takes messages or forwards calls as appropriate. Returns appropriate calls to members and staff as directed by provider or nursing staff. Orders and maintains supplies for the reception area. Inform providers or staff of members needing immediate attention. Performs other related duties as requested.

2008 - 2010 Kaiser Permanente - Kensington, MD

Vision Services Assistant I - Vision Essentials

Assist the vision service department by scheduling appointments, greeting and assisting patients, performing initial vision tests, and assisting ophthalmologists, optometrists and opticians. Make appointments for patients with optometrists and ophthalmologists. Greets patients, takes co-payments, enters data into medical records, and escorts patient to examination room. Review with patients the spectacle and contact lens options following diagnosis by optometrist. Advise patients in the selection of spectacle frames under direction of an optician. Performs minor adjustments and repairs to spectacles. Performs other related duties as requested.

2007 - 2008 Women for Women International - Washington, DC

Human Resources Administrative Assistant /Marketing Assistant

Perform administrative and office support activities for executive management and other staff. Greet and direct all visitors, including vendors, board members, job candidates and customers. Contact potential job candidates to schedule interviews. Post job vacancies with various sites online. Ensure completion of new employee paperwork, set-up computer connection, login and password along with telephone setup, sign-in and security procedures. Responsibilities include screening calls, making domestic and international travel arrangements and meeting arrangements, preparing reports and financial data, training and supervising other support staff, and customer relations. Prepare/tracking of all courier services, including FedEx, DHL, United States Mail and tracking of all incoming and outgoing faxes etc. Arrange for shredding services (pick-up/delivery of all bins) Maintain offsite storage facility and arrange for all materials to be sent to offsite storage. Handle conference room scheduling, audio/visual equipment, facilities maintenance requests and office supplies. Duties include support to the Chief Marketing Officer, marketing department staff, Senior Human Resources Manager, administrative and finance department staff. Additional duties include assisting with event planning, creating or updating presentation software files, tracking budgets, invoices, expenses, and communicating with external creative service providers.

2006-2007 Georgetown University Hospital - Washington, DC

Patient Financial Associate - Emergency Room

Obtain pre-authorization, insurance verification, basic benefits information and approved length of stays on all patients utilizing Medical Center clinical services and performs duties pertaining to registration to include the use of SMS, IDX, Care-medic, HDX and on-line managed care programs. Facilitate and/or obtain continuing authorizations where required, pre-authorization for consults and procedures on patients utilizing Medical Center Clinical Services. Assess, process, and refer patients for financial assistance and coordinate pre-treatment financial obligations. Obtain all insurance demographic and financial information pre-admission and enter/update the information in the hospital and physician registration systems. Obtain required signatures, confirm patient picture identification cards, give out mandatory literature and scan all financial documents.

2001-2006 Wolpoff and Abramson, LLC - Rockville, MD

Paralegal Medical Collector – Medical Collections

Under general supervision perform collection activities for assigned clients. Review unpaid accounts to determine appropriate action required. Contact debtor via phone and/or correspondence regarding reimbursement of unpaid accounts. Receive, review, research and respond to correspondence from insurance companies, attorneys and debtors. Researches and follows-up on denials and requests for additional information. Serve as liaison to hospital billing operation staff in the collection of accounts to ensure timely reimbursement. Identify and verify adjustments needed on accounts. Review payment history to identify payer trends and non-payment issues to determine if further legal actions are recommended. Adhere to FDCPA and HIPAA policy and procedures for collection standards.

Claims - Sr. Claims Processor

Review and process approximately 45 claims per day in accordance with contract, status, and Health plan principles. Handle client inquiries pertaining to the status of specific claims. Provide timely processing of claims. Research/resolve status questions from client services relevant to claim approval and significant policy issues. Maintain working relationships with clients and insurance companies to ensure timely, accurate processing. Articulate the basis for decisions on claim payment to clients based on knowledge of policies and procedures.

Claims - Insurance Verification Analyst

Review claims in accordance with contract, status, and Health plan principles. Handle client inquiries pertaining to the status of specific claims. Provide timely processing of claims. Research and resolve status questions from client services relevant to claim processing and forward significant policy issues to client attention. Maintain working relationships with clients and insurance companies to ensure timely, accurate processing.

1999-2001 Comcast Cable - Silver Spring, MD

Customer Account Executive - Call Center

Accommodate limited range of subscriber requests, inquiries and complaints. Handle large volume of incoming telephone calls, covering limited range of customer services in a prompt and professional manner, obtaining all information for resolution of transaction. Answers customer questions regarding billing, service problems, products and features and corrects errors and discrepancies on customer billings as necessary. Prepares work orders for maintenance requests after determining if field visits are required, and ensures appropriate follow-up procedures are met. Perform billing and posting of customer accounts. Resolves delinquent account balances.

1998-1999 Montgomery Village Care and Rehabilitation- Gaithersburg, MD

Business Office - Bookkeeper/Medical Billing/Accounts Receivable/Receptionist

Handle large volume of incoming telephone calls, covering limited range of customer services in a prompt and professional manner, obtaining all information for resolution of transaction. Answer customer questions regarding billing issues and payment posting, correct errors and discrepancies on customer billings as necessary. Prepares claims for billing to insurance companies and ensures appropriate follow-up procedures are met. Receive and performs insurance payment and private payment posting of customer accounts. Resolves delinquent account balances. Prepare bank deposits daily. Maintain daily census of patients within the facility. Prepare all correspondence for Business Office. Receives and reviews all incoming mail.

1997-1998 Shady Grove Radiology - Montgomery Village, MD

Scheduler – Scheduling

Receive large volume incoming calls from patients, nurses and doctors to schedule appointments for radiology procedures. Assists patients, nurses, doctors by answering questions in review of what tests are needed and schedule appointments appropriately. Advise patient/nurse/doctor of preparation for procedure being scheduled. Obtain prescription from patient, nurse or doctor to review for verification of proper procedure. Request any previous x-rays or medical records for date of scheduled appointment. Obtain/review insurance information to ensure that procedures are covered. On occasion perform transcription of doctor's notes as requested.

1994-1997 Chestnut Lodge Hospital - Rockville, MD

Administrative Assistant to Director of Nursing - Administration

Provide administrative support to Director of Nursing and staff. Assist with development and maintenance databases. For tracking data, prepares distributes reports and analyses of date. Coordinates and maintains calendar, meeting and special deadline dates for Department. Prepares meeting packets and provide minute taking support to staff for meetings. Makes travel arrangements. Tracks budget and assists in researching reconciling budget. Receive, screen all incoming calls to appropriate staff member. Acts as department point of contact with nursing staff personnel. Provide word processing other document preparation. Compose and prepare correspondence. Create and maintain office library.

1994-1997 Chestnut Lodge Hospital - Rockville, MD

Counselor PT – Children’s Cottage

Maintain a safe, supportive and loving environment. Teaching and supervising basic hygiene practices. Teaching respect for the rights of others and fostering good interpersonal relationships. Enforce the rules of the home. Maintain a clean, safe and attractive home. Assure clean and adequate clothing in good repair. Assuring that the child is eating a proper amount of nutritionally adequate food. Oversee the health needs of the child. Teach self-control. Apply discipline and penalties within prescribed limits to correct unacceptable behavior. Serve as Case Manager, interfacing with the Program Administrator, teachers, and family, in order to carry out the treatment plan for the child, attaining goals in education, behavior modification, living skills, and interpersonal relationships. Participation in staff meetings, consultant meetings, weekly team meetings and others as required. Participate in all training sessions as assigned. Perform all administrative duties. File incident reports when appropriate. Taking proper crisis intervention action when necessary and other related duties and activities as assigned.

1993-1994 Phillips Publishing Inc. - Potomac, MD

Business Services - Supervisor, Subscription Services (Healthcare Periodicals)

Supervise staff of seven employees in the operation of order processing. Receive and process daily the subscription service requests for Healthcare periodicals. Ensure that all requests are complete and error free. Enter request into data entry system. Process all payments for subscriptions via check, credit card. Resolve any incomplete orders by contacting subscriber for verification. Balance the daily revenue report of all subscription service requests received and transfer report to the home office. Provide statistics to the Accounting Department daily, and report to the Director of Subscription Services. Approved all leave requests of employees. Review time and attendance of unit staff. Perform evaluations of staff. Hold weekly staff meetings to apprise staff of any changes or concerns. Attend monthly staff meeting of the department. Perform other duties as assigned.

1988-1993 State of Georgia/Dekalb County Health Department – Decatur, GA

Senior Secretary – Office of Infectious Disease/Sexually Transmitted Disease Unit

Perform routine clerical and administrative functions such as drafting correspondence, scheduling appointments, organizing and maintaining paper and electronic files, or providing information to callers. Make copies of correspondence or other printed material. Locate and attach appropriate files to incoming correspondence requiring replies. Operate electronic mail systems and coordinate the f Manage projects or contribute to committee or team workflow of information, internally or with other organizations. Compose, type, and distribute meeting notes, routine correspondence, or reports, such as presentations or expense, statistical, or monthly reports. Open, read, route, and distribute incoming mail or other materials and answer routine letters.

Provide services to customers, such as order placement or account information. Review work done by others to check for correct spelling and grammar, ensure that company format policies are followed, and recommend revisions. Conduct searches to find needed information, using such sources as the Internet. Manage projects or contribute to committee or team work. Order and dispense supplies. Coordinate conferences, meetings, or special events, such as luncheons or graduation ceremonies. Arrange conference, meeting, or travel reservations for office personnel. Develop or maintain internal or external company Web sites. Prepare conference or event materials, such as flyers or invitations.

1986-1988 State of Georgia/Division of Public Health – Atlanta, GA

Secretary – Office of Human Resources

Compile and keep personnel records. Record data for each employee, such as address, weekly earnings, absences, amount of sales or production, supervisory reports, and date of and reason for termination. May prepare reports for employment records, file employment records, or search employee files and furnish information to authorized persons. Process, verify, and maintain personnel related documentation, including staffing, recruitment, training, grievances, performance evaluations, classifications, and employee leaves of absence. Explain company personnel policies, benefits, and procedures to employees or job applicants.

Record data for each employee, including such information as addresses, weekly earnings, absences, amount of sales or production, supervisory reports on performance, and dates of and reasons for terminations.

Gather personnel records from other departments or employees. Examine employee files to answer inquiries and provide information for personnel actions. Answer questions regarding examinations, eligibility, salaries, benefits, and other pertinent information. Compile and prepare reports and documents pertaining to personnel activities. Request information from law enforcement officials, such as previous employers, and other references to determine applicants' employment acceptability. Process and review all employment applications in order to evaluate qualifications or eligibility of applicants. Arrange for advertising or posting of job vacancies, and notify eligible workers of position availability.

1985-1986 State of Georgia/Governors’ Office of Children & Youth – Atlanta, GA

Administrative Assistant – Juvenile Justice Coordinating Council

Perform routine clerical and administrative functions such as drafting correspondence, scheduling appointments, organizing and maintaining paper and electronic files, or providing information to callers. Make copies of correspondence or other printed material. Locate and attach appropriate files to incoming correspondence requiring replies. Operate electronic mail systems and coordinate the f Manage projects or contribute to committee or team workflow of information, internally or with other organizations. Compose, type, and distribute meeting notes, routine correspondence, or reports, such as presentations or expense, statistical, or monthly reports. Open, read, route, and distribute incoming mail or other materials and answer routine letters. Provide services to customers, such as order placement or account information. Review work done by others to check for correct spelling and grammar, ensure that company format policies are followed, and recommend revisions. Conduct searches to find needed information, using such sources as the Internet. Manage projects or contribute to committee or team work. Order and dispense supplies. Coordinate conferences, meetings, or special events, such as luncheons or graduation ceremonies. Arrange conference, meeting, or travel reservations for office personnel. Develop or maintain internal or external company Web sites. Prepare conference or event materials, such as flyers or invitations. Mail newsletters, promotional material, or other information. Arrange conference, meeting, or travel reservations for office personnel. Establish work procedures or schedules and keep track of the daily work of clerical staff. Prepare conference or event materials, such as flyers or invitations. Track legislation for alternatives to incarceration of youth. Visit YDC (youth detention centers) to review facilities and check status of policies and procedures. Interview all youth detention center detainees for problems or concerns.

REFERENCES “AVAILABLE UPON REQUEST"

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