SUMMARY

A customer service professional with experience in handling customer inquiries, resolving problems, and providing benefit plan information. Expertise includes dealing with a wide variety of people including physicians, pharmacists, vendors and customers.

PROFESSIONAL EXPERIENCE

INDEPENDENCE BLUE CROSS, Philadelphia, PA 2006 to present

Senior Billing Analyst (2014-current)

Research & resolve internal & external incoming billing inquiries from customer via email or phone for fully insured customers, Groups, Individual (Direct pay) and Government (Medicare).

Escalate grievances and or issues that cannot be resolved at the time of the call or email to require additional investigation.

Assist customers with setting up payment processing through the member online portal and Zipchecks.

Develop tracking and reporting for all Executives Inquiries to be shared with management including time to handle, nature of grievance etc. Identify root causes from issues to avoid future grievances.

Processing billing/payment adjustments due to retroactive enrollment and/or to assure proper payment allocation for group and non-group accounts.

Provide on the job training and motivation to specialist in order to accomplish prompt, accurate and courteous responses to all types of inquiries.

Perform effective quality control functions by reviewing work processed within the unit for accuracy and completeness.

Updating reporting packages and management reports within the framework of company policy and guidelines, referring situations to the supervisors with recommendations for solutions based on completed research.

Billing Analyst (2011-2014)

Research & resolve internal & external incoming billing inquiries from customer via email or phone for fully insured customers, Groups, Individual (Direct pay) and Government (Medicare).

Escalate grievances and or issues that cannot be resolved at the time of the call or email to require additional investigation.

Assist customers with setting up payment processing through the member online portal and Zipchecks.

Develop tracking and reporting for all Executives Inquiries to be shared with management including time to handle, nature of grievance etc. Identify root causes from issues to avoid future grievances.

Processing billing/payment adjustments due to retroactive enrollment and/or to assure proper payment allocation for group and non-group accounts.

Clarify charges and/or related information in response to customer inquiries.

Senior Billing Specialist (2008- 2011)

Provide on the job training and motivation to specialist in order to accomplish prompt, accurate and courteous responses to all types of inquiries.

Process specially assigned large prestigious groups payments.

Perform effective quality control functions by reviewing work processed within the unit for accuracy and completeness.

Updating reporting packages and management reports within the framework of company policy and guidelines, referring situations to the supervisors with recommendations for solutions based on completed research.

Billing Specialist II (2007 – 2008)

Ensures the accurate and timely application of group wire premium payments

Respond to member and group billing issues efficiently, accurately and in a timely manner.

Processes billing/payment adjustments due to retroactive enrollment transactions

Investigate requests for refunds and initiate refunds when appropriate.

Billing Specialist (2006-2007)

Handles telephone inquiries from members, group administrators, and other plan associates in a courteous and professional manner.

Responsible for thorough research of payments in order to resolve premium discrepancies

Processing billing/payment adjustments due to retroactive enrollment and/or to assure proper payment allocation for group and non-group accounts.

Clarify charges and/or related information in response to customer inquires.

EXPRESS SCRIPTS INC., Horsham, PA 1999 – 2006

Customer Service Associate (1999-2006)

Handle customer service inquiries from members, pharmacies, physicians and internal and external clients related to pharmacy benefits. Assist members in understanding and maximizing the use of their pharmacy distribution program.

Handle 80+ daily calls from patients, physicians and retail pharmacies.

Assist patients with refill requests, prescription order status updates and any questions concerning their prescription benefits via inbound calls and email.

Aide pharmacies and physicians with processing rejected claims and prior authorizations.

Clarified charges and/or other related information in response to patient inquiries.

Provided guidance to patient questions regarding website navigation, registration and location of information.

EDUCATION

B.A., Secondary Education/Social Studies

Cheyney University, Cheyney, PA

TECHNICAL TRAINING

Windows Operating Systems, Microsoft Applications, Internet, and Email

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