Customer Service Medical

CARLISHA N. MITCHELL

**** ***** ****** *** *-*, Durham, NC 27705 H: 919-***-**** *************@*****.***

Summary

Customer Service Specialist with a can-do attitude and willingness to help at all times. Dedicated to providing excellent customer service and making operational and procedural improvements.

Skills

Proficient at Microsoft Office, especially Microsoft

Professional and mature

Word, Excel, and PowerPoint

Dedicated team player

Knowledge of operating standard office

Strong interpersonal skills

equipment, e.g. a scanner/printer

Self-starter

Excellent time management, organization, and

Claims appeal procedures

attention to detail

Insurance eligibility verifications

Clear verbal and written communication

Experience

Customer Service Specialist Manager

05/2015 to Current

Conduent, Inc.

Cary, NC

Data Entry, Individual Medicare, Medicare Medical Claims and Benefits, Pharmacy Claims and Benefits, Medicare Supplements and IPA for several states, Billing and Enrollment Description: Inbound and Outbound calls for Individual Medicare members. Provide Medical and Prescription Benefits and Accumulations. Provide status on the processing of Medical and Prescription claims. Set up automatic payments as well as make one-time payments for members. Resolve member issues and answer questions to those who call on the member's behalf (POA/EOE) per HIPAA Guidelines set by Center for Medicare and Medicaid Services (CMS). Speak with providers in regards to eligibility for pharmacy as well as pharmacy claims. Completed tracking reports to keep up with individual and site wide performance and to make sure that agents are following normal procedures and protocols based off CMS and HIPAA. Developed and implemented policies, procedures and process improvement initiatives to improve retention rates and increase customer satisfaction.

Medical Office Administrator

05/2014 to 09/2015

Doctors Making House calls

Durham, NC

Cooperated with Medicare, Medicaid and private insurance providers to resolve billing issues.

Scheduling appointments, medical procedures, medical equipment, etc. for patients in Assisted and independent

Living Facilities.

Received and distributed faxes and mail in a timely manner.

Customer Service Representative

01/2005 to 11/2009

Sport Endeavors, Inc.

Hillsborough, NC

Selling soccer and lacrosse clothing and equipment. Providing customer with information on new products.

Handle customer complaints in a professional manner. Selling of Gold Club membership to offer customers

special items and collect point for free products.

Education and Training

Associate of Arts

Piedmont Community College Roxboro, NC, United States

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