Customer Service Insurance
Resume:
Nakia Jones
**** ******** ** *********, ** *****
704-***-**** Home 704-***-**** Cell
Customer Service Specialist
OBJECTIVE
Pursuing an interest in obtaining a permanent position with an expanding establishment that allows me to utilize my skills in customer service, communication, organization, and the ability to work well with others.
SKILLS
Proficient with Microsoft software, time management, medical insurance, medical terminology, data entry, phone etiquette, case management, and navigating multiple monitors. Capable of meeting and exceeding production with the ability of working under limited supervision. Experience with EMR, B Client Works, Centricity Business, Avaya & Cisco hard and soft phone systems.
PROFESSIONAL EXPERIENCE
AllCare Pharmacy Plus
Care Manager,50 Bearfoot Rd Northborough,MA
July, 2017-August 2017
Complete verification process to protect HIPAA laws. Locate providers and facilities in the given network. Assist members and providers with registration and navigating the online portal.
Determine out of pocket expenses and accumulators such as copays, coinsurances, and deductibles. Review explanation of benefits and research claims to provide payment information and determine denial reasons.
Advised of any prior authorizations and pre certifications that are required for a medication or a procedure. Identify fee schedules and verify coverage for J codes and CPT codes to determine eligibility. Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance
Provide customers with courteous, friendly, fast and efficient services
Update job knowledge by participating in educational opportunities and training activities
Work efficiently both individually and within a team accomplish required tasks
Maintain and improve quality results by adhering to standards and guidelines and recommending improved procedures
Reimbursement Counselor October 1, 2016-July 27, 2017
Lash Group, 2320 Cascade Pointe Corporate Center One Charlotte, NC
Answer inbound calls and making outbound calls to patient, physician and field representatives for the manufacturer
Contact insurance companies for benefits investigation and coverage eligibility
Provide customers with courteous, friendly, fast and efficient services
Explaining benefits coverage to patient and physician
Explore the different options for the patients to get assistance with medication
Assist the patient with specialty medication.
Providing shipment assistance with monthly delivery.
Advised of any prior authorizations and pre certifications that are required for a medication or a procedure. Identify fee schedules and verify coverage for J codes and CPT codes to determine eligibility. Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance
Reimbursement Counselor August 2014-October 2016
Lash Group, 1800 Innovation Blvd Fort Mill, SC
Answer inbound calls and making outbound calls to patient, physician and field representatives for the manufacturer
Contact insurance companies for benefits investigation and coverage eligibility
Provide customers with courteous, friendly, fast and efficient services
Explaining benefits coverage to patient and physician
Explore the different options for the patients to get assistance with medication
Assist the patient with specialty medication.
Providing shipment assistance with monthly delivery.
Advised of any prior authorizations and pre certifications that are required for a medication or a procedure. Identify fee schedules and verify coverage for J codes and CPT codes to determine eligibility. Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance
Access Specialist August 2005-July 2014
1000 Blythe Blvd Charlotte, NC
Make follow up appointments for Specialty and physician
Referral for different specialty. Call the insurance companies to find out the coverage and copays for the patient. Obtained the patient deductible or out of pocket cost for the procedures and/or appointments.
Called insurance companies to obtain patient in office procedures
Collected copay and/or outstanding billing issues.
Enter the patient demographic information.
Used EMR systems to retrieve Medical Records under the HIPPA guidelines
Posted payments to patient accounts using ICD-10 Codes
Check in and check patient out of the office
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