Customer Service C

RONALD B ALLARD J R.

**** * ***** * *** W yndmoor, P A 1 9038 ■ 2-15-836-****■ 2-67-625-**** ■ E mail: R onald- ***********@*******.***

OBJECTIVE: T o o btain a p osition w here I c an m aximize m y m anagement s kills, c ollections a nd c ustomer service e xperience w ith o pportunities f or g rowth a nd a dvancement. SUMMARY OF QUALIFICATIONS: A ccomplished as a collections manager, call center support, customer service oriented positions and medical billing in fields banking and healthcare for over 10 years. Specializing in high volume collections, implementing proposals and sale promotions for various companies. Detailed-oriented hard worker with strong analytical and strategic planning abilities. Proficient in utilizing software: MS Excel, MS Outlook, SAP, MS Power Point, MS Word, Windows, Lotus 123, Word Perfect 6.1, 1-Vault and On Demand. Demonstrated interpersonal and communication skills and ability to effectively communicate across all organizational levels. Self-starter, able to adapt quickly to new environments, programs, and situations. PC Literate: Systems are AS400 and typing with a keystroke of 70 wpm. Account Receivable, and Payroll. Healthcare Scheduling for I/P and O/P Hospitals and Medical Facilities using ICD-9 and ICD-10 codes. Advanced in EDI (835) with segments, Elements and Response file reader to translate information t o D octor’s o ffices, P roviders a nd M edical D irectors. WORK E XPERIENCE

C otiviti ( Contract)

● Document M anagement T echnician

● Conshohocken, P A – S eptember 2 016 t o M ay 2 017

● Working i n a H IPPA c ompliant E nvironment

● Familiarity w ith m edical d ocumentation t hrough f iling, e lectronic p rocessing o r c laim h andling. Recognition o f c ommon t erminology s uch a s C laim n umber, D ate o f S ervice, P rovider N ame, Provider n umber, A ppeal, E DI E tc.

.

L eHigh V alley H ealth N etwork

A llentown, P a D ecember 2 015- M ay 2 016

• Organize, i mplement a nd m aintain S cheduling m anagement s ystem s upporting i dentified projects a nd t heir p lans.

• Interact w ith c ustomers, m anagers, f inancial c ontrollers a nd E VM, E pic A nalyst, E DI ( 835)

• Can r emain f ocused d espite d istractions i n a f ast-paced e nvironment.

• Attention g iven t o d etail a nd c onsistent d esire t o d o a ccurate w ork. C an s ee t he u nderlying detail t hat o thers m iss.

• Solid c ommunication s kills – b oth w ritten a nd v erbal i .e. s peaks a nd w rites u sing a ppropriate and c lear g rammar/spelling.

• Takes o wnership o f d aily w ork g oals f or p roductivity a nd q uality.

• Ability t o s olve b asic p roblems a nd r ecognize w hen e ven a r outine c ircumstance r equires a different a pproach.

• Strictly a dheres t o a ll c ompany p olicies a nd f ederal r egulations f or t he h andling o f p ersonal health i nformation.

. P re-Certification R epresentative

A etna H ealth I nsurance

B lue B ell, P A – N ovember 2 014 t o D ecember 2 015

● Performs i ntake o f c alls f rom m embers o r p roviders r egarding s ervices v ia t elephone, f ax, E DI.

● Utilizes e T UMS a nd o ther A etna s ystem t o b uild, r esearch a nd e nter m ember i nformation.

● Screens r equest f or a ppropriate r eferral t o m edical s ervices s taff.

● Approve s ervices t hat d o n ot r equire a m edical r eview i n a ccordance w ith t he b enefit p lan.

● Performs n on-medical r esearch i ncluding e ligibility v erification, C OB, a nd b enefits v erification. Maintains a ccurate a nd c omplete d ocumentation o f r equired i nformation t hat m eets r isk M edical Directors.

Promotes c ommunication, b oth i nternally a nd e xternally t o e nhance e ffectiveness o f m edical management s ervices ( e.g., c laim a dministrators, P lan S ponsors, a nd t hird p arty p ayers a s w ell a s member, f amily, a nd h ealth c are t eam m embers r espectively). Support t he a dministration o f t he p recertification p rocess i n c ompliance w ith v arious l aws a nd regulations, U RAQ a nd/or N CQA s tandards, w here a pplicable, w hile a dhering t o c ompany p olicy and p rocedures. U ses A etna S ystems s uch a s Q NXT, P roFAX, P roPAT, a nd M illiman C riteria.

● EDUCATION

● Grand C anyon U niversity, P hoenix, A Z P resent M ajor M arketing

● Delaware S tate U niversity, W ilmington, D E, 1 989 – 1 992, 2 001

● Springfield H igh S chool, E rdenhiem, P A G raduated 1 989, D iploma