Cindi Nicole Lounds

*** ********* ***.

Baltimore MD,21218

410-***-****

ac0z6k@r.postjobfree.com

Objective: To acquire a position in a professional environment that will allow me to utilize my professional skills and knowledge I have acquired, and to also further my knowledge to become successful.

Experience:

Senior Claims Examiner

February 2016- Present

Trizetto

Examining and entering complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.

Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.

Approving, pending, or denying payment according to the accepted coverage guidelines.

Identifying and referring all claims with potential third party liability (i.e.,. subrogation, COB, MVA, stop loss claims, and potential stop loss files).

Maintaining internal customer relations by interacting with staff regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information, and updating information to claim file with regard to claims status, questions or claim payments.

Patient Account Rep III

September 2014- November 2015

University of MD FPI

•Review accounts to determine appropriate insurance follow up

•Perform charge entry

•Post payments and rejections

•Apply the correct diagnosis and procedure codes based on documentation and payer specific requirements

•Submit medical claims to insurance for consideration of payment

•Kept management informed of billing issues; and other duties as assigned

Medical Account Auditor

May 2014- July 2014 Temp Position

Mobile X USA

•Reviewed Patient Medical Charts for medical necessity and all authorizations for mobile Radiology Services

• Contact Medical Providers via out bound calling and fax request for signed orders or scripts for radiology service

• Prepare and send claims and authorizations to Medicare for payment

• Process and send refunds for overpayments to clients

Customer Service Team Lead

Jan 2014-April 2014 Seasonal Temp

Maryland Health Connection

•Incoming call center

• Enrollment and Application Qualification for health insurance (commercial and Medicaid)

• First Call / Problem Resolution

• Assist with training of team members •Answered question for team members

• Resolved all escalations and complaints transferred from team and Performed follow up calls to clients

Customer Account Examiner II

Nov 2012- Aug 2013

Comcast

• Incoming call center

•Explained Calculated and apply Credit Adjustments to accounts as required

•Resolve customer complaints

•SALES MAJOR - upgrade existing accounts

•Perform credit checks for new applicants

•Complete work orders for technicians to install service and accurately schedule orders

•Accept electronic payments by telephone

Medical Claims Examiner

July 2011- Nov 2012.

Johns Hopkins Healthcare

• Process and pay medical claims for Priority Partners, JH EHP, and PAC insurance including COB claims

• Review claims to ensure provider office has billed correctly

• Readjucate and release claims for payment and or deny services appropriately

Customer service Rep

May 2010- July2011

Johns Hopkins Healthcare

• Answered multi lined telephone in an inbound call center environment, for Priority Partners Insurance provided by Johns Hopkins

• Spoke with both Members and providers

• Enrolled new member into the insurance

• Updated member accounts if there were any demographic changes, also changed member primary care providers, issued new insurance cards, and located different providers (PCP & Specialist) upon member request and provided contact information for the providers

• Verified insurance coverage for both members & providers

• Spoke with providers in reference to claim & authorization status

• Also quoted member benefits as to what services are covered and what services were not covered also what service required authorization and how to obtain authorization

• Referred member to their case workers at the local department of Social Service gave locations of the main office and telephones

Customer Service Rep

December 2009-May 2010

Medifast

• Answer multi-lined telephone in an inbound call center environment

• Assisted member in their weight loss journeys by connecting them with life/health coaches in their area

• Placing orders for their daily food supply and shipping it to them directly via UPS, FED Ex, or local mail

• Also tracked packages upon their request

• Informed members of the daily promotions and accepted payments by telephone to process orders

• Placed orders for the life/health coach materials and shipped it to the coaches via mail

Customer Service Rep II

December 2008 - September 2009

Baltimore Gas & Electric Company, Baltimore, Maryland

• Answer Multi-lined telephone in call center environment

• Schedule appointments to start and stop service

• Schedule orders to transfer accounts from one address to another

• Performed credit and background checks for new applicants

• Answered calls from 911 dispatchers for gas & emergency purposes

• Submitted claim for discourtesies, complaints, damages and bill disputes

• Answered calls for Electric trouble/outages and gas emergences/leaks

Customer Service Rep I

August 2007 - December 2008 Baltimore Gas & Electric Company, Baltimore Maryland

• Answer Multi-lined telephone in call center environment

• Calculated customer bills

• Supplied information about energy assistance programs

• Answered inquires about tree trimming and paving jobs

• Answered calls from 911 dispatchers for gas & electric purposes/building fires

• Submitted claims for discourtesies, complaints, damages and bill disputes

• Answered calls for Electric trouble/outages and gas emergences/leaks

Medical Service Rep

March 2007 - June 2007 Johns Hopkins Hospital @ EBMC, Baltimore, Maryland

• Create medical charts for new patients

• Pulled charts for walk in patience, and next day appointments and at the request of the doctors

• Copy patient records upon request

• Answer multi-lined telephone system

• File charts and clinical notes alpha and numerically

• Locate patients in IDX system

Education

Baltimore, Maryland

January 2006 - January 2007 Baltimore City Community College

Major: Nursing

Baltimore, Maryland

September 2002 - June 2005 W.E.B. School of Science

Major: Science

References

Available upon request

Contact this candidate