Medical Customer Service
Resume:
Maria Claudia Gamez
Miami, FL 33196
***************@*****.***
Objective
Seeking a challenging role within the medical field in a company where my knowledge and skills can be used and nurtured and utilizing my ability to assist patients professionally and provide the highest level of service.
Experience
Present - 2011 Humana/ Care Plus Health Plans Miami, FL
Member Service Representative
Directly respond to questions, resolve concerns and provide guidance on transactions, inquiries, and complaints from both internal and external members.
Receive, document, and resolve customer inquiries by using established best practices.
Educate members about care plus health plan products and services both over the telephone and through face-to-face briefings.
Understand the importance of dealing with confidential information.
Resolved problems or forwarded to managers as needed to diffuse intense situations and frustrated callers.
Updated client information to ensure prompt collections.
2010 -2007 Gastro Health PL CBO Office Miami, FL
Accounts Receivable Specialist/ Medical Biller/ Collector
Audit claims and search for underpayments
Collect claims data to be reviewed EMR experienced
Write appeal letters as needed to payers to resolve denials
Knowledge of ICD-9, CPT-4 and /or HCPCS coding systems
Experience performing account resolutions with third party payers
Accounts payable accounting experience
Responded to patient billing directed to suitable departments
Collected and posted payments and recorded receipts
Assisted patients with all aspects of insurance billing resolution or payments and documented any information or conversations in the computer regarding the patient's accounts.
2007 -2003 Department of Veteran Affairs Medical Center Bronx, NY
Accounting Technician/ Accounts Receivable Leader
Medical care cost funds program; responsible for medical collection n outstanding receivables owed to the government
Identify cases which resulted in sources of recovery of funds
Ensure that all procedures are followed within guidelines of the statute of limitations.
Handling electronic explanations of benefits from insurance companies
Account receivables.
Education
Present Miami Dade College Health Care Administration
2006 -2004 Plaza College (Honors List)
Medical Billing and Medical Coding
Business Law
Medical Terminology
1988 Francis Lewis High school Queens, NY
Summary of Skills and Qualifications
Proven ability to give exceptional customer service to patients and clients
Excellent verbal and written communication skills
Organizational and Interpersonal skills
Over 10 years in clerical experience in healthcare setting as a medical collector
Highly skilled in greeting patients and registering their concerns in the log book
Hands-on experience in explaining the charges to the patient
Knowledge of medical terminology, billing processes, and computer systems
Identifying queries and customer complaints and finding solutions
Hardworking, Energetic, and Self-motivated
Bilingual – Spanish and English
Contact this candidate