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Customer Service Data Entry

Glenville, West Virginia, United States
August 11, 2018

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*** **** ***** **

Apt ***

Glenville, NY 12302



To obtain employment with a reputable company and be placed in a position where I can gain upward mobility and become a great asset to the company.


10/2016 – Present (as well as 1-3/2016, 11/2012-3/2014)

Self-Employed - Independent Construction Contractor:

Remodel kitchens, bathrooms and basements

Install hardwood and ceramic tile flooring

Framing, sheetrocking, taping, spackling, sanding

Installing electrical outlets, switches, breakers, lighting

Rough and finished plumbing for showers, sinks, hot water tanks and heating

Build decks, porches, stairs

Frame and install doors

All forms of construction, carpentry and remodeling

3/2016 – 10/2016

Saratoga Hospital - Inpatient Hospitalist Physician Coding Specialist

Assisted a team of 20+ Inpatient Hospitalists, NP’s and PA’s on accurate coding practices

Billing specialist liaison for Inpatient Hospitalists with Strategic Solutions

Coded, processed and billed Inpatient Hospitalist physician charges

Coded, processed and billed Inpatient Mental Health physician charges

Studied ‘Code H’ for accurate inpatient notes documentation

Departmental liaison for Inpatient Hospitalists

Attended weekly/monthly Inpatient Hospitalist meetings for updates and process improvements

3/2014 – 1/2016

Community Care Physicians - Medical Coder / EMR Specialist

Code provider super bills for charge entry: diagnosis, office visit level, injections, labs, specialty services, and physical exams

Reference EMR for information to include diagnosis, pre-op encounters, utilization management, special procedures such as lesion removal, cervical biopsy’s, wart treatment. No Fault and Workers Comp information. Member insurance information, injectable encounters for all ‘J’ codes etc.

Charge entry for large primary care group (Latham Medical Group)

Establish professional relations with provider staff to aid in completion of encounter for charge entry via email and phone

Worked closely with Provider Compliance Dept for the processing of encounters for provider review

Completion of 8 week ICD 10 review class

Versed in ICD 9 & 10 (ICD 10 certification is forthcoming)

4/2003 – 11/2012

Blue Shield of Northeastern New York:

Network Management Provider Contracting/Credentialing Specialist (2008-2012)

Sent/received provider credentialing material to/from provider offices

Fielded provider relations calls

Conducted telephone onsite reviews and after hour calls

Assisted external reps with claims troubleshooting and adjustments

Screened provider credentialing material to ensure proper protocols were followed

Attended onsite meetings with facilities and physician offices

Participated in yearly on and offsite educational provider expos

Responsible for providing training to new team members

Government Programs Team Leader / New Hire Assistant Trainer (2006-2008)

Responsible for training new hires

Assisted staff on phone inquiries

Resolved problematic supervisory phone calls

Performed and administered quality reviews

Created necessary corrective action plans for staff not performing at acceptable levels

Created and implemented new processes and supporting training documentation

Initiated and scheduled meetings to discuss department issues and updates

Assisted manager in staff performance appraisal scoring and issuance

Microsoft Outlook, Word, Excel, Power Point

Customer Service/Claims Operation Rep. in the Out of Area (BlueCard) Dept. (2003-2006)

Assisted with phone inquiries re: claims, eligibility, etc…

Received & processed member/provider correspondence

Pulled claim reports for trending

Requested medical records to support duplicate procedures

Sent/received faxes/e-mails to other BlueCross/BlueShield plans

Interpreted/relayed benefits to members/providers

Trained staff on claims retrieval system

Working familiarity with Medicare/Medigap plans

Microsoft Outlook, Word, Excel, Power Point

10/2000 – 4/2003 Stay at Home Dad

9/1998 - 10/2000

MVP Healthcare - Senior Membership Specialist/Data Entry Department Trainer:

Created and maintained training manual for new/existing staff

Trained and oversaw new employees on data entry

Assisted supervisors in performance assessments and yearly appraisals

Worked closely with supervisors to identify re-training needs based on error trends

Performed and documented quality review on employee’s daily work

Created and distributed daily stats to personnel

Processed enrollment/change forms

Group administrator for New York State contracts

College Education

1992 – 1993 Hudson Valley College Troy, NY (Major: Criminal Justice)

1995 – 1996 Schenectady County College (Major: Criminal Justice)

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