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Customer Service Medical Billing

Location:
San Antonio, Texas, United States
Posted:
January 31, 2019

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Resume:

Lucius Smith

Career Resume Banking

San Antonio, TX

ac8cuc@r.postjobfree.com

210-***-****

Authorized to work in the US for any employer

Work Experience

Debit Card Dispute Analyst

USAA Federal Savings Bank - San Antonio, TX

October 2017 to December 2018

Handles all aspects of the dispute process to include: Re-presentments, Arbitration Chargeback, Pre- Compliance, Compliance, Fraud, Pre-Arbitration, Arbitration and Good Faith. Resolves member disputes related to Debit Card Signature transactions. Provides and engages in customer service activities to determine member needs and provide appropriate resolution.

Communicates the results of a dispute inquiry to a member in a professional manner. Seeks guidance from senior team members to resolve issues and to identify appropriate issues for escalation.

Maintains current Electronic Funds Transfer Act (Regulation E) and Bank Card Association Rules. Processes Provisional and/or Permanent Credit to members account. Acquires and uses advanced knowledge of industry practices and trends. Demonstrates knowledge of USAA's key business priorities.

Demonstrates basic knowledge of USAA's business and external environment. Demonstrates knowledge of USAA's members, products and services.

Use of systems such as VROL, DCC, just to name a few. Q/A Research Analyst - Mortgage

USAA Federal Savings Bank - San Antonio, TX

September 2016 to August 2017

Address inquiries from vendors, investors, Portfolio Managers, etc. professionally and in a timely fashion. Update Mortgage Electronic Records System, Inc. (MERS) database to ensure adequate reporting of changes in mortgage servicing rights and beneficial ownership interests in loans serviced by SMS. Research various systems for information on closed/inactive, active, current, delinquent, specialized accounts, loan history, and create work items to all bank lines of business if applicable. Review daily task queue and exception reports to ensure completion of assigned duties within specific SLAs.

Update and annotate all actions/follow-ups processed on loans in all appropriate systems. Mortgage Collector II

Wells Fargo - San Antonio, TX

June 2015 to January 2016

• Engage customers via inbound and outbound calls to discuss the delinquent status of their mortgage loan

• Responsible for assuring all regulatory requirements are met concerning customer interaction by explaining policies and procedures courteously and patiently

• Maintains confidentiality of customer’s nonpublic information

• Provides information and knowledgeable assistance regarding mortgage loans

• Maintains customer records on servicing platform

• Builds customer relationships by actively listening and resolving complaints quickly, efficiently, and accurately

• Provides written and verbal responses to customer inquiries as needed

• Other duties as assigned.

• Effectively utilizes a variety of credit bureau reporting tools such as Credit Bureau Reporting Agency websites, and other systems to identify type of dispute received and manually perform a reasonable investigation required by FCRA Regulation for direct and indirect disputes.

• Possesses the ability to utilize various systems to research information on closed/inactive, active, current, delinquent, and specialized accounts, manually pull account statements, loan history, and create work items to all bank lines of business if applicable.

• Learns to research, resolve, and provide timely responses to Litigation/Legal requests.

• Effectively initiates contact with Credit Bureau Reporting Agencies via telephone, and secure email correspondence to maintain effective communication between the agencies and data furnisher.

• Collection and analysis of credit reporting data for deficiencies and implementation of processes to ensure data quality/integrity

• Implementation and execution of daily/monthly quality reviews to ensure processes are in compliance with Fair Credit Reporting Act (FCRA)

• Analysis and creation of requisite modifications to existing processes with the introduction of enhancements

Medical Billing/Collector

KCI - San Antonio, TX

September 2014 to July 2015

• Review claims for accuracy. Performs needed corrections.

• Evaluates need for attachments to claims.

• Locates attachments within TPP.

• Submits complete claims to payers.

• Reviews discharge report from order entry systems and inputs discharge dates into A/R system.

• Reviews and inputs discharge dates from TPP research.

• Corrects transaction lines based on discharge dates.

• Generates corrected claims based on above corrections.

• Corrects billing rates and generates corrected claims.

• Corrects start and stop bill dates and generated corrected claims.

• Corrects billing cycles and generates corrected claims.

• Corrects payer profiles related to bill-tos.

• Reviews and correct claims sent to lost days.

• Correct bill-tos and regenerates claims to payers.

• Documenting actions in notes.

•Verify third party payer benefits and eligibility (online or telephonically).

•Review and analyze payer specific requirements and coverage criteria to determine required documentation and accurate billing criteria.

•Conduct in depth review of clinical documentation (medical records, prescriptions, operative reports, history and physicals) based on billing criteria.

•Call customer or field personnel to obtain missing documentation required for placement and/or billing. Could include home health agencies, patients, hospital/facilities, physicians.

•Contact patient to coordinate delivery of product. Communicate patient's financial responsibility and any special instructions.

•Follow-up post delivery to obtain any additional documentation to support billing criteria. Collection Specialist II

SWBC - San Antonio, TX

September 2010 to July 2014

•Receives new and continuing claims submitted, determines coverage under Payment Protection, sets them up in the systems, and prepares/disburses the claim files to the Examiners.

•Creates claim payments in the system, enters claim notes in the systems, maintains carrier transaction reports, and balances such for each carrier to ensure accuracy with the issuance of payments.

•Takes incoming phone calls to assists claimants, financial institutions, and carriers to include documenting such within claim files and in the claims system.

•Requests missing information to establish new claims from the claimants and financial institutions.

•Trains and assists the Claims Processing Clerk.

•Maintains Monthly Outstanding Balance insured listing reports for every financial institution and requests any missing reports from premium processing; and prepares files for storage and maintains reference material used by the department such as listing of financial institutions.

•Runs various claim reports and maintains the letters within the claims correspondence system by creating new template letters and making changes to existing.

•Resolves inbound and makes outbound service calls regarding routine collateral protection insurance coverage questions, inquiries and/or problems on the status of insurance on loans made by borrowers/ members, financial institutions and insurance agents by researching, verifying, updating loan insurance information and documenting the affected account's history file.

•Responsible for meeting or exceeding quality expectations to ensure customer satisfaction.

•Handles most complex calls with minimal assistance (lapses, waives, BIC's, and the like). Provides assistance in and/or refers high-level, complex questions, problems or client complaints to appropriate resources to ensure customer satisfaction.

•Prepares DI confirmation letters for borrowers/members for approval; creates internal management reports; and assists in special projects.

•Enters updates to pertinent insurance data from Document Management System or FAX into the computer system in a timely manner ensuring accuracy, completeness, and adherence to department procedures.

•Prepares, packages, and mails insurance policies, proof of insurance requests, and paid certificates to borrowers/members and financial institutions.

Makes outbound phone calls to various financial institutions' members in an attempt to collect payment, arrange for payments, and/or recommend settlements or foreclosures on overdue loan utilizing effective telephone collection techniques and principles while meeting call service levels.

•Negotiates, coordinates payments, and responds to inquiries with members to include conducting searches via phone or Internet to determine location of members and referring collection issues resulting in incorrect payment amounts and/or payment adjustments to the Team Lead.

•Updates call results and enters any other pertinent information into both SWBC and the appropriate FI's databases by maintaining a records of all customer contacts.

•Processes electronic payments upon members' approval using the ECM system.

•Refers complex questions, problems or client complaints promptly and accurately to the appropriate resources to ensure customer satisfaction.

Quality Assurance Analyst

Accenture - San Antonio, TX

April 2012 to February 2013

Reviewed work completed by the loan processors and updated work:

• Order appraisals, flood determinations and open title.

• Verify income, send out verification forms and conduct regular follow-ups for outstanding documents.

• Maintain an open line of communication with the applicant throughout the processing period, assisting them with any questions and notifying them of any additional required information.

• Monitor incoming mail and documents for information verifying the data collected. Ensure these are imported into the paperless system. Track progress to ensure compliance with loan stipulations.

• Complete a final evaluation of the completed application package and prepare the file for approval, specifying any applicable conditions to the approval.

• Review the commitment and prepare any additional required disclosures.

• Prepare file for final underwriting and closing department review.

• Manage and maintain record of all loans in process.

• Strong member service skills and communication skills.

• Strong analytical skills.

• Ability to interact with members and third party vendors in a professional manner.

• Knowledge of fundamentals of mortgage lending process.

• Ability to manage multiple priorities and meet deadlines in a fast paced high volume work environment.

KNOWLEDGE of FHA, VA USDA, Fannie Mae, Freddie Mac guidelines. Bankruptcy/Foreclosure Specialist

Bank Of America - San Antonio, TX

February 2011 to March 2012

Responsible for a group of high level risk bankrupt accounts and applying Bankruptcy Code requirements to those accounts.

Responsible for high level account analysis based on Bankruptcy Code and general collection law.

•Reviewing and investigating alerts, performing investigations, or enhanced due diligence reviews for potentially suspicious activity; making risk-based SAR recommendations and preparing SARs.

•Conducting periodic holistic reviews of higher risk individuals or entities

•Maintaining a solid working knowledge (functional and operational) of the rules and regulations, including but not limited to, BSA, USA PATRIOT Act, and Sanctions Screening.

• Effectively initiates contact with Credit Bureau Reporting Agencies via telephone, and secure email correspondence to maintain effective communication between the agencies and data furnisher.

• Collection and analysis of credit reporting data for deficiencies and implementation of processes to ensure data quality/integrity

• Implementation and execution of daily/monthly quality reviews to ensure processes are in compliance with Fair Credit Reporting Act (FCRA)

• Analysis and creation of requisite modifications to existing processes with the introduction of enhancements

Assistant Manager/Mortgage Collections

Wachovia Bank - San Antonio, TX

February 2007 to March 2008

Verifies, compiles, and types application information for mortgage loans: Reviews residential loan application file to verify that application data is complete and meets establishment standards, including type and amount of mortgage, borrower assets, liabilities, and length of employment. Utilizes a variety of credit bureau reporting tools such as Credit Bureau Reporting Agency websites, to identify type of dispute received and perform a reasonable investigation required by FCRA Regulation for direct and indirect disputes.

Utilize various systems to research information on closed/inactive, active, current, delinquent, and specialized accounts, pull account statements, loan history, and create work items to all bank lines of business.

Research, resolve, and provide timely responses to Litigation/Legal requests.

•Manages the staff and activities involved with severely delinquent account collections to include monitoring and verifying work schedules and attendance records; conducting performance evaluations; providing coaching, counseling, and discipline; and resolving personnel related issues.

•Serves as primary point of contact for clients for any operational questions or issues.

•Performs all clients reporting and service level deliverables to include ensuring collection goal attainment.

•Performs Collector file reviews to ensure department work standards are being met; and establishes and maintains effective communication with financial institutions to ensure client expectations are being met.

Credit and Collections Supervisor

Lacks Furniture Store - San Antonio, TX

September 2003 to January 2007

Assist in managing the collections process

Collect revenues and protect company assets

Counsel customers to gain timely renewal payments

Contact customers directly who have not made payments to get the customer current Maintain and update customer database and assisted with customer merchandise returns as needed. Negotiated mutually acceptable payment arrangements when necessary and followed up in a timely manner.

Accurately document comments / actions taken on customer accounts to maintain good tracking and history on the system(s) of record. Facilitate resolution of disputed balances via research and/or reconciliations.

Researched requests for credits and re-bills and resolved them in a timely manner. Effectively utilizes a variety of credit bureau reporting tools such as Credit Bureau Reporting Agency websites, to identify type of dispute received and manually perform a reasonable investigation required by FCRA Regulation for direct and indirect disputes. Possesses the ability to utilize various systems to research information on closed/inactive, active, current, delinquent, and specialized accounts, manually pull account statements, loan history, and create work items to all bank lines of business if applicable. Learns to research, resolve, and provide timely responses to Litigation/Legal requests. Education

High school Diploma in General Studies

John Jay high school - San Antonio, TX

September 1982 to June 1986

Skills

Fraud (3 years), Debit Card Disputes (4 years), Dispute Resolution (5 years), Customer Service (10+ years), Collections (10+ years), SAP (10+ years), KYC (10+ years), Epic (2 years), Excel (10+ years), EDI (2 years), Cadence (5 years), AML (3 years), Credit Bureau (5 years), Management, database, training

Certifications/Licenses

Driver's license

Additional Information

Completed DCC and Fraud training for Debit Card Disputes department at USAA.



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