Customer Service Medical

MONICA L. LILLY

**** ****** ** ********, **** ***11

321-***-**** **********@***.***

CUSTOMER SERVICE SPECIALIST

Multifaceted and service-focused professional with strong knowledge and background in various customer service and patient account specialist functions in Medical and Health Care Management, with proven ability to work effectively in busy environments with positive results. Dependable and results oriented with in-depth knowledge of professional medical principles and techniques, healthcare operations, and practice-related software. Highly organized and detailed with the ability to effectively multi-task several complex assignments with tight deadlines. Self-starter, with a team-oriented attitude possessing strong analytical and interpersonal skills coupled with excellent written and oral communication skills.

Core Competencies

Healthcare Customer Service Functions Patient Account Coordination & Management

Customer Service Office Correspondence

PROFESSIONAL EXPERIENCE

Heathnet Federal Services, Columbus, Ohio 2017-present

PC3 Escalation Specialist

Provided customer service support to Veterans’ Administration Medical Center(VAMC)

Veteran’s customers with enrollment, benefits, access to care and claim issues.

Informed senior management, Congressional Relations and Grievances, and legal of any perceived liabilities, including Potential Quality of Care (PQI) Issues.

Ensured compliance with program requirements, performs audits, identified areas for improvement and participates on the teams convened to analyze process issues and correct any areas of vulnerability.

Kept Veteran and Health Net's management informed of resolution process and provides ongoing education to Veteran, Providers and VA.

Immediately and thoroughly researches each escalated case to identify root cause and estimate level of severity and impact (e.g., customer service staff coaching opportunity, potential delay of care, etc.)

Provided feedback to supervisors and quality assurance team on coaching opportunities.

Utilized escalation data to track and trend issues for management intervention and potential discussions with the Department of Veterans Affairs.

Trained new hires on processes to ensure he/she was successful.

Supported multiple VAMC such as Columbus, Ohio New Jersey with appointing.

Subject matter expert on Care in the Community for VA Fargo ND.

OSU Physicians, Columbus, Ohio 2008-2016

Patient Account Representative II

Receive inbound/outbound calls from patients regarding hospital and physician invoices.

Answer patient inquiries about billing, procedures, policies, and available services in a timely manner.

Act as a liaison between patients and insurance companies; facilitate communication between patient and physicians, medical staff and administrative staff.

Coordinate payment plans to ensure payments for hospital and physician services.

Contact Medicaid and Managed Care to verify dates of service and coverage.

Accurately process payments, reconciles, and open and close batches on a daily basis.

Educate patients on the various financial assistance programs and HCAP.

Trained several new hires and seasoned staff on IDX and IHIS.

Protect and observe patient confidentiality per policies and procedures.

Answer over 100 inbound and outbound calls per day.

Subject matter expert on mychart and Madison Health Specialty.

RG-Crown Bank, FSB, Casselberry, FL 2005- 2007

Collection Counselor Specialist Lead

Analyzed branch and customer needs to determine the best method to resolve bad debt.

Reviewed payment list, maintained departmental files and prepared paperwork for debit, credits, and other payments.

Contacted credit bureaus for customer’s reports, verified references, and updated addresses.

International liaison for customers in the United Kingdom, collected Home Equity Line of Credit and commercial; and mortgage accounts

Ordered liquidations, foreclosures and repossessions.

Prepared daily and monthly reports on the status of delinquent accounts.

Wells Fargo Financial, Lake Mary, FL 2003-June 2005

Collection Specialist Lead

Contacted customers for payment arrangements by utilizing the technology of an Auto dialer via inbound and outbound.

Act as credit counselor to resolve outstanding delinquency to bring the account current.

Maintained professional working relationships with customers by using effective listening skills and promoting constructive problem solving on all contacts.

Supervised staff to ensure they were meeting and exceeding company goals.

Monitored verifications and completed annual staff evaluations.

Operationalized dialer for agents to call outstanding delinquent accounts via automatic dialer.

Ocwen Federal Bank, FSB, Orlando, FL 1997-December 2002

Customer Service Group Lead

Assisted new agents with questions; work with agents to develop their skills via one on one interaction while on the floor. Observed and monitor daily performance.

Coached agents to correct performance with quality issues being addressed. Managed work/flow/adjust schedules.

Researched accounts to resolve problems regarding payments, misapplied funds. Edited letters, set-up mail merge, handled escalated calls.

Supervised the Executive services department. Ensured adequate coverage during peak hours. Answered escalated calls from customers.

Completed forbearance plans, processed verification of mortgages and payoffs. Training of employees in India to include completion of training manuals on standard operating procedures.

Education

Eastmoor High School, Columbus Ohio, 1980-1984

School of Computer Technology, Pittsburgh, PA, 1984-1986

Guam Community College, Tamuning, GU, 1991-1992

Certified Nurses Assistant (California)

Licensed Life & Health Agent (Tamuning Guam)

Valencia Community College, Orlando, FL, 2000-2001

Proficiencies

Management Systems, Lotus, Word, Data Entry, 10-Key, REAL-E, Technekron, Seas, Davox, Noble Internet, Typing, Outlook, Excel, Zeng-Miller Supervisory, Six Sigma Training, ACD, Meridian, AS400, Realvision, Mortgage vision, Teambuilding, Coaching and Mentoring, Anzio, Sapphire, Accurint, CMS, MortgageServ, Fiserv, George Reports, Speed pay, Visio, Webex, Medical Terminology, IDX, Dataonline, IHIS,Data Ark, Ohio Mits, Xpeditor, RevRunner, Doma,FE Tool, Jabber, Quantam Choice, Front End, Tool. Revenue Cycle, Medical Billing, 1500 Claim Forms, UB40, W9.

Reference available upon request

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