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Customer Service Medical

Location:
North Charleston, South Carolina, United States
Posted:
November 13, 2017

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HAZEL SHEFTON

**** **** ******* ****, **********, SC 29412 C: 843-***-**** email: hazel0504 @aol.com

PROFESSIONAL SUMMARY

I am a dedicated Certified Professional Coder with HEDIS Specialist training and former Quality Assurance Specialist with twenty-four years of healthcare experience formerly at MUSC Physicians. I am detail-oriented with experience in medical coding, teaching medical billing and coding, health care quality improvement, abstracting clinical information from medical records, customer service call center and audited all work processes and procedures of Patient Accounting staff including customer service, payment posting, insurance denial follow-up processes, registration, credit processing and claim coding edits. Provided research data analysis and recommendations for the development and/or implementation of current and/or new processes and procedures to enhance effectiveness.

SKILLS

•CPT and ICD-10 medical coding experience

•Former medical billing and coding instructor

•HEDIS measures training

•Extensive medical records training

•Call Center Customer Service experience

•Knowledge of NCQA HEDIS abstracting guidelines

•Understand insurance benefits and collections procedures

•Familiar with commercial and private insurance carriers

•Research data analysis

•Composed and professional demeanor

•Close attention to detail

•Excellent verbal communication and problem solver

•EPIC EMR System experience

•Microsoft application proficient

•Adept multi-tasker

WORK HISTORY

Call Center Customer Service, 06/26/2017 to present

Dial America – 8085 Rivers Avenue, N. Charleston, 29406

•Utilize sales strategy to offer products and services

•Enroll clients into Medicare HMO or Supplement health plans

•Upsell products and/or services to customers

•Deliver superior service by identifying and resolving customers’ issues

Medical Records Field Tech, 07/03/2017 to 08/08/2017

CiOX Health – 15458 North 28th Place, Phoenix, AZ 85053

•Visit provider sites to scan/copy medical records

•Utilize company laptop and scanner to retrieve medical records

•Upload scanned medical charts to corporate data center

•Comply with all PHI regulations

HAZEL SHEFTON

1094 Fort Johnson Road, Charleston, SC 29412 C: 843-***-**** email: hazel0504 @aol.com

WORK HISTORY CONTINUED

HEDIS Specialist, 01/04/2017 to 03/20/2017

AmeriHealth Caritas (Contracted through Techlink Systems Inc) – 4390 Belle Oaks Drive Ste 400 N. Charleston, SC 29405

•Performed medical records abstraction in support of annual Healthcare Effectiveness Data and Information Set (HEDIS)

•Applied auditing criteria to medical records to determine compliance with standards

•Entered results of chart audits into database

•Utilized software applications (QSHR and Excel) to support HEDIS operations

•Visited provider sites to identify, copy and collect selected medical records

•Called provider offices to acquire updated information

Medical Coder II, 06/2015 to 02/02/2016

MUSC Physicians - 1 Poston Road Suite 260 Charleston, SC 29407

•Upon review of charge documentation, code CPT, ICD-10 and applicable modifier.

•Review charge documentation to validate accuracy of CPT, code ICD-10, HCPCS and modifiers.

•Ensure proper procedures are followed and meet federal, state and third party payer initiatives

•Maintained productivity standards coding over 200 radiology charges daily

Medical Billing and Coding Instructor, 09/08 to 12/2015

Centura College - 8084 Rivers Avenue N. Charleston, SC 29406

•Deliver education services to students

•Prepare course plans and materials

•Teach medical billing and coding courses

•Monitor progress and attendance

•Advise students

•Record grades and submit reports

•Provide tutoring

HAZEL SHEFTON

1094 Fort Johnson Road, Charleston, SC 29412 C: 843-***-**** email: hazel0504 @aol.com

WORK HISTORY CONTINUED

Quality Assurance Specialist, 09/1997 to 06/2015

MUSC Physicians – 1 Poston Road Suite 350 Charleston, SC 29407

•Diligently audit all Patient Accounting employees' work in third party follow-up, claims billing, customer service, registration, payment posting, credit processing and billing systems employees.

•Compiled necessary documents in Quality Assurance database for audit report packages.

•Maintained updated knowledge of all Patient Accounting employees work processes for auditing purpose.

•Performed qualitative analysis of system processes to ensure accuracy and consistency.

•Resourcefully used CPT and ICD-9 coding books and procedure manuals to audit Billing Systems Coder Specialist.

•Maintained updated knowledge of coding requirements through continuing education, certification renewal and acquiring ICD-10-CM certificate.

Credit Analyst, 07/1995 to 09/1997

MUSC Physicians - 1 Poston Road Suite 350 Charleston, SC 29407

•Reviewed, analyzed and resolved invoice/account credits.

•Responded to recoupment correspondence from insurance companies.

•Accurately posted refunds to insurance carriers and patients/guarantors.

•Updated patient financial information to guarantee accuracy.

Payment Poster, 03/1994 to 06/1996

MUSC Physicians - 1 Poston Road Suite 350 Charleston, SC 29407

•Accurately posted insurance carrier and patient/guarantor payments and adjustments.

•Updated patient insurance carrier information to guarantee accuracy

•Maintained payment posting productivity standards.

•Accurately posted insurance recoupment, correspondence denials, applied to deductibles and payment posting edits.

Cash Processor/Registration Clerk, 11/1993 to 09/1994

MUSC Physicians - 1 Poston Road Suite 350 Charleston, SC 29407

•Accurately wrote insurance carrier and patient/guarantor payments and adjustments to be posted by Payment Posting area.

•Updated patient registration and insurance carrier information for team members.

HAZEL SHEFTON

1094 Fort Johnson Road, Charleston, SC 29412 C: 843-***-**** email: hazel0504 @aol.com

WORK HISTORY CONTINUED

File Maintenance Data Coordinator, 03/1992 to 11/1993

MUSC Physicians -Haborview Towers, Hagood Ave Charleston, SC 29403

•Precisely verified and updated patients and guarantors’ insurance benefits and eligibility.

•Updated patient demographics information to guarantee accuracy.

•Identified and updated patient insurance benefits for lab and pathology outreach areas.

•Updated insurance benefits for Charge Entry area.

Claims Assistant, 10/1990 to 01/1992

Employee Benefit Services (Currently Thomas Cooper) - 14 N Adgars Wharf Charleston SC 29401

•Correctly processed checks and worksheets to medical providers and insured individuals.

•Adeptly did mail data input of incoming claims and filed enrollment insurance cards.

Administrative Specialist A, 09/1989 to 06/1990

College of Charleston Orientation Department -66 George Street Charleston SC 29424

•Meticulously produced letters, memos and reports for the Orientation Department.

•Adeptly handled inquiries for newly admitted students.

•Hired temporary and student workers.

Registered Financial Rep/Management Trainee, 02/1988 to 02/ 1989

First Investors Corporation -615 Wesley Drive Charleston, SC 29407

•Diligently set appointments with clients to provide financial planning and service to enable clients to achieve their financial goals.

•Recruited applicants for management trainee position.

•Interviewed new applicants and help determine suitability.

•Complied with federal and state regulations governing registered representatives.

•Conducted sales training of registered representatives.

•Managed office log of procedures.

Registered Financial Rep/Management Trainee, 02/1988 to 02/ 1989

First Investors Corporation -615 Wesley Drive Charleston, SC 29407

•Diligently set appointments with clients to provide financial planning and service to enable clients to achieve their financial goals.

•Recruited applicants for management trainee position.

•Interviewed new applicants and help determine suitability.

•Complied with federal and state regulations governing registered representatives.

•Conducted sales training of registered representatives.

•Managed office log of procedures.

HAZEL SHEFTON

1094 Fort Johnson Road, Charleston, SC 29412 C: 843-***-**** email: hazel0504 @aol.com

WORK HISTORY CONTINUED

Administrative Customer Service Clerk, Express Mail, 03/1986 to 12/1986

United States Postal Service -JAF Building New York, NY 10101

•Diligently received incoming calls from customers and other postal offices on lost or delayed express mail.

•Verified the accuracy of express mail delivery receipts present in the computer system.

•Produced reports for the office manager and supervisors.

•Did surveys that relate to express mail.

Personnel Employee Clerk, 11/1984 to 02/1986

United States Postal Service -JAF Building New York, NY 10101

•Meticulously interviewed applicants for postal employee jobs.

•Diligently typed and assembled all required official personnel forms for newly hired personnel.

•Office mail manager for the Employment and Placement units.

•Trained new office personnel clerks in office procedures.

Claims and Inquiry Clerk/Distribution and Window Clerk, 08/1970 to 11/1984

United States Postal Service -JAF Building New York, NY 10101

•Accurately sorted the mail and did window clerk services.

•Served as personnel clerk on special assignment revising employees' work schedules, monthly reports, all disciplinary and transfer records.

EDUCATION

• 09/1978 to 06/1979: Music - 10 Credits,

City College/University - New York, New York

•02/1975 to 01/1978: Business/Music - 25 Credits, Baruch College - New York, NY

•09/1971 to 08/1974: Accounting/Business - 63 Credits, Pace University - New York, NY

HAZEL SHEFTON

1094 Fort Johnson Road, Charleston, SC 29412 C: 843-***-**** email: hazel0504 @aol.com

CONTINUING EDUCATION

•American Academy of Professional Coders (AAPC) Professional Medical Coding Course (PMCC) certification of completion

•MUSC Physicians ICD-10-CM Medical Coding (certification of completion)

•First Investors Corporation N.A.S.D Training in securities (certification of completion)

PROFESSIONAL CERIFICATES AND REGISTRATIONS

•Certified Professional Coder (AAPC) 03/2011

•Certificate of ICD-10-CM Proficiency 08/2014

•Registered Financial Planner (Federal and State of SC) 1988



Contact this candidate