DARLENE EVANS
Objective:
I am seeking to obtain a full-time position with career growth potential that will allow me to utilize and enhance my current skills while developing more skills. With the expectations of new heights and growth. I bring with me my several years of experiences and various skills into a new era of my career life.
WORK EXPERIENCE
BENEFIT SPECIALIST / TRAINER
Affordable Care and Implants - Morrisville, NC
January 2018 – July 2018
Provide training via webinar on the various dental insurance plans to the dental practice staff members
in over 240 locations nationwide.
Respond to inquiries via emails, skype and/or incoming calls from external and internal clients regarding
various claims issues, web portal passwords, fee schedules, scheduling trainings, and more.
Updating billing entities and accounts, ePrescribing enrollments, resetting web portal and
applications passwords.
Troubleshoot various problems with the dental claims processing system, Dentrix.
Document calls and email responses into the SalesForce application.
INSURANCE BILLING SPECIALIST
PFS Group - Cary, NC (Contract)
May 15, 2017-August 14, 2017
Provided regular daily communication with insurance companies to ensure timely resolution of account balances and patient’s eligibility for date of service
Placed outbound calls and received incoming calls to facilitate collection and resolution of insurance accounts
CLAIMS SPECIALIST
IBM Seterus – Durham, NC
April 4,2016-March 31,2017 (Contract)
Reconciliation of mortgage claims in foreclosure and bankruptcy
Researched and sorted through various documents by utilizing multiple resources such as Safeguard, SCI, Lereta, QBE, Loansphere, MSP, Home Tracker and NETR to locate and pull all necessary documents usable to obtaining reimbursement from FNMA of services paid to maintain and preserve real estate properties
Troubleshot the root cause of curtailed claim items and resubmitted claim with supporting documentations to promptly collect payments on services previously provided
SENIOR CUSTOMER CARE REPRESENTATIVE/RECEPTIONIST
MVP Health Care – Rochester, NY
April 1997-July 2015 (Senior Customer Care Representative)
November 1995-April 1997 (Receptionist)
Responded to customer inquiries in areas of enrollment, premium billing/payments, claims, benefit interpretation, and referrals/authorizations for medical care and prescription (Rx) services
Provided support to other CSRs and the handling of escalated issues (calls)
Operated within the Macess, Facets and AMISYS claims processing systems
Performed service issue research and resolution, reporting, special projects, etc.
Comprehended and serviced a variety of insurance types including HMO, POS, EPO, PPO, ASO, Indemnity, Medicare and Medicaid
Received and logged all forms of premium payments
Answered phones and greeted clients
Performed miscellaneous office duties including filing.
SKILLS
Proficient with Microsoft Word and Outlook
Intermediate level of Excel
Strong PC skills using Windows applications
Excellent oral/written communication and effective interpersonal skills
Trouble shooting/problem solving skills
People person
Strong organizational skills
Comprehension of HIPAA regulations and compliances
Steadfast to providing excellent customer service and process improvement
Able to maintain self-control in the face of hostility and function effectively under pressure
Type approximately 60 wpm
Medical terminology
Critical thinking / resourceful
Mentor/Trainer