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Customer Service Medical

Location:
Phoenix, Arizona, United States
Salary:
$18 - $20
Posted:
May 24, 2018

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Resume:

Tammy Tomasino

**** * ******** ** #****, PHOENIX, AZ, 85035

T: 602-***-**** F: E: ac5lmd@r.postjobfree.com

Profile

Stimulated in an environment that includes critical thought process, identifying trends, interpersonal relationships, problem resolution, travel, and conflict resolution in many aspects of health insurance. Secure a position with a variety of responsibilities in which experience in Provider Relations, Claims Processing, Public Speaking, and Customer Service can be utilized. Exceptional in written and verbal communication skills.

Experience

Provider services Claims Educator, CMDP, 4000 N Central Ave #2200 01/2015 to present

Responsible for provider recruitment and provider education & training; AzAHP enrollment forms and provider demographic updates, maintain QNXT provider records via weekly reports, support providers with their concerns including compliance of rules and regulations, Federal and State Laws, and statutes pertaining to CMDP and AHCCCS, travel statewide for on-site review audits, educate providers with claims filing process, special projects, assist with credentialing, and backup claims processor.

Claims Processor, corporate job bank/CMDP, 4000 N Central Ave #2200 05/2013 - 01/2015

Claims provider liaison responsible for assisting providers with claims inquiries, eligibility verification, verify dental history and assist foster caregivers when billed by providers. Professional claims processor responsible for accurate payment resolution with state and Title-XIX medical claims processing with a goal of 10 day turn-around from time of receipt; applying plan benefits and treating every claim as if it were my own child’s.

Barista, Starbucks Coffee Co, Avondale, AZ, 85392 10/2012 - 05/2013

Responsible for making hand crafted customer beverages as well as store front tasks such as stocking supplies and product preparation, cleanliness, and treating every customer like my new best friend.

Front office/accounts receivable, Abdominal Surgeons Ltd, 07/2011 - 08/2012

Came to be known as the “Bariatric Patient Whisperer” as I give patients the compassion they look for in a doctors’ office. Responsible for scheduling appointments obtaining authorizations, check-out desk, nutrition sales, and follow up billing issues.

Claims Processor III, UHC, Phoenix, AZ 07/1989 - 11/2010

Professional claims processor responsible for quality claims processing of medical, dental, vision, and hospital claims. Research complex claims issues. Apply federal and state statutes and regulations to process claims. Experience also includes Customer Service Representative responsible for benefit description, appeals inquiry, general benefit questions and listening to the customer with empathy.

Skills

Experienced in QNXT, PMMIS, CHILDS, EClinicalWorks, and NextGen. Claims processing - medical, dental, including EDI, vision and hospital; medical (including pediatric) and dental terminology coding; 1500 and UB form knowledge; excellent communication skills verbal & written; Customer Service - claims and appeals inquiry, benefit description, interpret explanation of benefits, general benefit questions. Medical information systems. My previous work experience includes; Medical Billing/Accounts Receivable and medical front office; retail and direct sales. Microsoft Office Word, Excel, PowerPoint, Outlook, Windows XL; iMac - iWork, Pages, Numbers, and Keynote.

Accomplishments

Received Certificate of Training with DCS

Creating and maintaining desk reference for Provider Services team.

Excellent oral and written communications skills – knowing when less is more and/or details are necessary

Hand selected as best of the best to participate in fast paced pilot training class with UHC.

Received awards for outstanding employee as follows: monthly CORE award (twice), yearly CORE award and quarterly PEAC award with PL&A.

Hand selected to participate in IDEA committee to improve processes and implement new ideas with PL&A.

Volunteered to work as liaison, handling all customer service priority adjustments resulting in time efficiency for customer service follow-up and in quicker service to the customer with PL&A.

Worked on the ground floor in implementing “Golden Gate” bridging the gap between customer service and claims processor with PL&A.

16 years claims processor

Education

Ashford University

Completed 73 credits

Major: Project Management; 45 credits

Minor: Political Science and Government; 18 credits

Certificate of Training from Arizona Department of Child Safety

Core Values

Don’t take anything for granted

Know when to take advantage and when not to

Learn from mine and others mistakes

Be open minded

Keep learning

Be happy

Pursuing a goal, no matter what it is, brings me happiness. …Always have a goal.



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