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Customer Service Medical

Jacksonville, Florida, United States
April 10, 2018

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Darline Marcelle Washington, CPC

904-***-**** Mobile

904-***-**** Home

Professional Profile

Customer Service and Claims Operations with over 10 years’ experience in the insurance and healthcare industries. Quick study, conscientious, dedicated and dependable. Excellent oral and written communications skills. Ability to proactively, research and resolve problems.

Assurance Wireless 11/2017-Present

Provide wireless service and lifeline assistance to consumers who meet the Federal or State specific eligibility criteria. Screen & determine consumers eligibility though the Solis System via computer entering data information for participates that are in certain public assistance program.

Baptist Primary Care-Reedy Branch 03/2014-9/2017

Provides referral assistance to physicians, patients, and insurance companies. Schedule appointments, obtains authorizations, and collect patient responsibilities at the time of scheduling. Provides business services for patients and the healthcare system; Complete patient registration prior to scheduled appointment also post charges, and payments and assisting patients as needed.

MCCI Medical Group 12/2011-07/2013 Travel Referral Coordinator:

Process referral requests for the varies MCCI primary care centers in the Jacksonville/Callahan area for

all providers practicing within the clinic module and ensuring that when the needed referral/precertification/authorization numbers are obtained for specialty visit and outpatient, and inpatient services; Schedule routine and follow up appointments for patients; Update patients demographics & insurance prior to appointment, and schedule procedures for surgeries or any services requested; Medical coded physician visits; labs as needed or request.

University of Florida Healthcare 08/2007-12/2011 Medical Secretary-Referral Coordinator:

Obtain precertification for patients prior to Cardiology scheduled procedures such as Catherization; EP Study; Tilt and other procedure for the cardiovascular clinic. Performs routine clerical duties, and provides a standard of excellence as it relates to the customer service and satisfaction for all patients.

University of Florida Healthcare 09/2004-08/2007 Senior Department Secretary - Dean of College: Primary coverage as department secretary for the dean of the college, and for the general receptionist for the department; meet and greet patient, customers and physicians and provide assistance and/or refer to the correct area. Answer incoming calls and transfer calls to appropriate area. Type and prepare correspondence reports, and excel spreadsheet. Schedule and Track provider education (HIPPA-Compliance) training accurately, and record training, and attendance and distribute reports to varies department chairs monthly.

Humana Healthcare Inc. 07/1988-03/2003 Referral Coordinator/Claims-Adjuster/CSR:

Processed referrals for medical service received in a call center environment; effectively reviewed and authorized referrals request not requiring medical review. Ensured compliance with HCFA; NCQA; and other regulatory agencies. Processed claims for HMO; PPO; POS; Medicare and Medicaid products. Working knowledge of the HCFA 5010. Investigated and determined appropriate benefits allowance and denials. Provide quality customer service through timely accurate claims payments.


Certified Professional Coder American Academy of Professional Coder

Register Medical Assistant Florida College of Medical Careers Jacksonville, Florida

Certified Home Health Aide Florida Community of College of Jacksonville

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