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Customer Service Medical

San Francisco, California, United States
May 16, 2018

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Carly Alford

Oakland, CA ***** H: 510-***-****


Medical Registration, Admitting Representative – Versatile, resourceful, and results-oriented professional with excellent ability to multi task and prioritize different levels of urgency and need. Within diverse professional settings SKILLS

Medical terminology Understands insurance benefits ICD-9,/10 CPT coding, HCPC, Modifier Ambulance coding familiarity Medicare, Medi-Cal, HMO, PPO, DME, Claims Composed and professional demeanor Customer Service/ Call Center Research and data analysis Patient Registration, Verify Insurance Office management professional Update patient information/ Demographics Excellent problem solver Epic, AS400, Legacy, Diamond, Apex Close attention to detail Familiar with commercial and private insurance carriers Adept multi-tasker Insurance and collections, Follow-Up Office support (phones, faxing, filing) Patient referrals expert Excellent verbal communication WORK HISTORY

Call Center Customer Service (Claims)

Superior Billing Center - Oakland, CA

2015 - present

In/outbound 80+Calls daily process denied- unpaid claims. Follow up and update expired Authorization/ Referrals and used Epic and Qnxt to edit claims using UB04/HCFA 1500, Patient registration, insurance verification Updated demographics, insurance information prepared referral authorizations request. Demonstrated excellent organizational, time management and multi-tasking skills with ability to prioritize tasks while utilizing strong interpersonal skills to work effectively with co-workers, payers, and customer Medical Authorization/ Registration Specialist

Medical Solutions - Palmdale, CA 2012-2015

Direct responsibility for using strong problem-solving, critical thinking, and decision making skills to evaluate and process UB04/HCFA 1500 claims. Handled TAR, authorization request in timely manner. 3rd Party Follow-up, Invoiced for claims reimbursement, posted payments, performed refunding, and processed patient/DMH and DME claims.

Patient’s eligibility, verification and claims status with insurance agencies. Entered orders into the EMR system efficiently and without errors.

Scheduled. Cancelled Appointments, Submitted Claims for payment follow-up on unpaid claims. Determined prior authorizations for medication and outpatient procedures. SOFTWARE

Tapestry, Apex Software, 35 wpm, 10 key, Mainframe, Diamond 725, All scripts, Meditek, Nexgen, Medicare-SAM, Medical Manager, IDX, DDE, Medicare CMS 1500 UB/O4, Medisoft, Microsoft Office, AS/400

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