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Service Representative Insurance

Location:
Luray, VA, 22835
Posted:
October 10, 2017

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Resume:

FLORINA JOAQUIN

*** ********** ***** **. ***********, VA 22610, 703-***-****, *******@*****.***

Objective

To secure position in the medical/health field and collecting payments through Third Party Billing which will effectively utilize my experience, knowledge and analytical skills to provide assistance and support as needed to stimulate my growth as a professional. To better serve and give quality feedback and service to the company, client and most of all the patients.

Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.

Experience

11/05/2012 to 12/15/2016 Client Service Representative/ Convergent Recycle Management

Knowledge working on the following Third Party Billing accounts:

Worker Compensation Accounts

Health Insurance/ Medicare/ Medical

Motor Vehicle Insurance Accounts

Self-Pay Accounts

Problem Claims Accounts

Patients Accounts

Job Descriptions:

Billing and follow up of insurance claims and working all client correspondence.

Verify patient’s health insurance eligibility and coverage.

Make appropriate calls when necessary to obtain insurance info from patient or employer for insurance coverage.

Enter correct claims information on the data base.

Follow up receipt of submitted bill and payment status on a regular basis.

Understanding of the denials and appeals process.

If payments were denied for any reason, obtain the denial reason and submit an appeal with proper documentations.

Draft Appeals for all underpaid accounts.

Call on insurance accounts and either refile or provide requested information (records, corrected bill).

If carrier was uncooperative, escalate call to their superior until bill is paid correctly.

Take payment arrangements from patients or employers and forward to the director or supervisor for approval from the hospital.

Draft and submit Utilization Review request for no- payment of the bill due to medical discrepancies.

Conduct State Fee Schedule for proper expected payment.

Understanding contracts used to process the bills for payment between client and insurance carrier to ensure proper payment.

Summarize accounts for closure when bill was paid correctly.

Follow-up accounts on a daily basis

Responds promptly to all written inquiries or notifies customer if there will be a delay in obtaining a final resolution to the problem.

Maintain aged inventory at within 30 days or less.

Respond to all incoming calls or return calls in a timely manner. Assist in other areas of the department determined by management

Knowledge of Microsoft Excel and Word, EPIC, Artiva,Citrix and FACS Systems

Yearly HIPAA Training

MONTHLY ACHIEVEMENTS REPORTS:

Monthly Achievement Reports:

May 2103- Teams top collector.

Nov 2013- Special Recognition Award to successfully met production numbers consistently.

Jan 2014- 164% Goals met.

Feb 2014- 104% Goals met and Teams top collector. Collected 185 accounts

Mar 2014-- Teams top collector. Collected 180 Accounts.

Mar 2014- Received a Star Honor recognition.

Dec 2014- Received Teams top collectors

Jan 2015- Met Team Goals

Feb 2015- Met Team Goals

April 2015- Met Teams Goals and Teams Top Collector. Collected 157 accounts.5

May 2015 - Met the Teams Goals

July 2015- Met Team Goals

Aug 2015- Recognition for meeting team goals.

Nov 2015- Met Team Goals

Dec 2015- Met Team Goals

March 2016- Star Honor Recognition

July 2016- Received Image Award

Sept 2016- Superlative Award.

Nov 2016- Honorable mention for Team Goals Award.

Employment was terminated due to Reduction in Force 12/15/2016.

2004-2008 Client Service Representative/ Specimen Management Department at Laboratory Corporation of America.

Worked night shift for years then moved to day shift as a Client Service Representative and provided hands on to sending out specimens during the day as part of my duty.

I served as a liaison between LabCorp branches and other specialty laboratories and its customers and patients in response to all inquiries and problems. Also answers questions from in-house issues on all diff erent department and add-on tests from the doctors’ offices.

Researches, troubleshoots and resolves customer’s problems and issues that includes in-house issues and all patient services locations.

Help with any questions from all patient service centers and doctors’ offices regarding test requirements and type of specimens needed to draw blood for tastings.

Daily communications and follow up with other LabCorp locations, clients and all outside testing facilities via email, phone calls and faxes regarding test results.

Daily follow communications for tests results from other laboratories contracted by LabCorp.

Daily checking of system generated reports, audit or pending lists to make sure that all test is sent out to all laboratories and in-house departments.

Follow up test results from all laboratories. Enter tests results into the systems which some are done manually and through system interface to doctors’ offices.

Daily checking of lists of results to ensure results are sent out to the doctors in a timely manner.

Serves as a back-up for staffs and supervisors when they are out on vacation.

OSHA and HIPPA yearly training.

Employment was terminated due to Reduction In Force. 08/06/2008.

2001-2004 Reference/ Send Out Dept. Supervisor at Laboratory Corporation of America.

Duties are as Follows:

Managing 13 employees and a Team lead

Training new staffs.

Time cards

Pulling and preparing specimens for packaging specimens for send out testing to different specialty laboratories.

Work Schedules for staffs.

Follow up shipped specimens if it arrived to their destinations.

Generates reports every morning.

2000-2001 Accessioner at Laboratory Corporation of America

Process and split samples for testing.

About Myself

Work with the team effectively. Communicating with others appropriately. Listening and responding to others. Handling conflict situations effectively. I treat customers, patients and associates with respect and fairly. I take initiative and responsibility for all tasks assigned. Identifying own learning needs. Performing duties according to duties and policies. Producing quality work in a timely manner and finding better ways and efficient ways to do things. Flexible and can adopt to any changes and handling stressful situations effectively.

Education

Graduate in Nursing 1978 St Rita College of Nursing Manila, Philippines

References

Katie Welch- Supervisor 888-***-****

Tonya Atwood -Director 888-***-****

Cheryl Mathews –co-worker 757-***-****

Amber Donald co-worker (703) 540-***-****



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