Germantown, MD 20874
Highly motivated and skilled professional with a dynamic establishment that values teamwork, initiative, vision and a proven ability to demonstrate visible achievements and a drive to meet organizational business objectives.
•Excellent customer service and people skills...
•Committed to fostering a cohesive and productive workplace environment
•Strong analytical skills, with natural, instinctive troubleshooting skills
•Versatility, adaptability, and willingness to tackle new responsibilities and multi tasks; self-assured, assertive, self-confident, and aggressive, Procedural Skills, Clerical Skills, Documentation Skills, Verbal Communication, Dependability and Team player
•Professionally ensures compliance with all audit policies and procedures
•Ability to drive change and execute process improvements across region - teach, coach, and train diverse groups of associates.
•Attention to detail
•Bilingual: English and French (Able to speak, read and write)
EMPLOYMENT EXPERIENCE :
Lash Group 9715 Key West Blvd 11/01/17-Present
Rockville MD 20850
Benefit Verification Specialist Call Center
•Under close supervision of the project Team Coordinators / Management team, the Benefits Verification Specialist will contact insurance companies, on behalf of the physician’s office, to verify patient specific benefits. The Benefits Verification Specialist will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefits coverage.
•Outbound Calls to Insurance Payers, will be scripted, following a Guide.
•Collects and reviews all patient insurance information needed to complete the benefit verification process.
•Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options according to Program specific SOPs.
•verifying patients insurance and obtaining prior authorizations
•Verification process could include electronic validation of pharmacy coverage and medical eligibility.
EUROP ASSISTANCE USA INC.
4330 EAST-WEST HWY STE 1000 03/10/2008 - 12/23/16
BETHESDA MD 20814
VERIFICATION OF COVERAGE AGENT AND CLAIM ASSIST 2
•Research out of country policy details from internal Chess system (Verification of all pertinent information i.e. Medical and Travel assistance coverage name, date of birth, policy information etc).
•Access SAX to verify information obtained from Chess system and correct discrepancies as needed.
•Enter all medical information and Travel Assistance coverage in claim file.
•Anticipate customers need and initiate actions to meet those needs.
•Respond quickly and appropriately to customer requests.
•Carry out responsibilities in a timely fashion requesting assistance as needed.
•Abide by policies and procedures of Worldwide Assistance.
•Work cooperatively within team and other departments.
•Provide timely feedback to customers and departments in a clear and concise manner.
•Continually strive to suggest and implement ways to improve personal, departmental and organizational performance.
•Relate to people from other cultures in an open, friendly, and accepting manner.
•Experience working in an insurance claims processing environment
•Collects and distributes corporate mail, tracks registered mail, and receives signature as receipt
•Sorts mail according to claim schemes and documents types
•Applies bar-code printing and any paper attachments
•Readdresses returned mail bearing incomplete or incorrect address.
•Undertakes printing of high volume outgoing mail items (EOBs, AR forms etc.)
•Folds letters or circulars and inserts in envelopes.
•Weighs & stamps outgoing mail by using the mail equipment
•Places documents into storage receptacles, such as file cabinets, boxes, bins, or drawers, according to classification and identification information
•Finds and retrieves information from files in response to requests from authorized users.
•Eliminates outdated or unnecessary materials, destroying them or transferring them to inactive storage according to file maintenance guidelines and/or legal requirements.
•Reviews the scanned documents and attach them to appropriate files (may need to create files as per protocols in place)
•Reviews the E-fax and E-mail documents and attaches to appropriate files
•Assigns the file and sets appropriate tasks for Claim Examiners, Specialist or Supervisors.
Handling Coordination of Benefits' Submissions & Recoveries
•Sends pertinent paperwork to the member within time frame
•Applies procedures for collection, all required information, and sign off.
•Submits the claim / bill along with all completed paperwork to the appropriate Insurance Carrier/Health Plan
•Identifies pending Recoveries and follows up with respective Insurance Carrier/Health Plan
•CHERRY LANE NURSING AND REHAB CENTER
9001 CHERRY LN, LAUREL, MD 20708
NURSING ASSISTANT 02/2007 – 03/2008
•Assisted in delivering a high standard of holistic care to patients, promoting their equality and dignity at all times.
•Assisted with patient hygiene, mobility, and physical comfort, eating and drinking, whilst observing and reporting specific changes.
•Performed and reported clinical observation of a patient’s temperature, pulse, respiration rate and blood pressure.
•Observed and reported changes in patient’s conditions to the Registered Nurse or Shift Co-coordinator.
•Obtained urine, stool and septum specimens, and performed urinalysis.
•Performed basic life support.
•Communicated effectively within the multidisciplinary team.
•Assisted in the maintenance of ward cleanliness.
•Assisted in the maintenance of equipment stock levels.
•Carried out all responsibilities with regard to the Center’s Equal Opportunities Policy.
•Maintained a safe and healthy environment for patients, visitors and staff.
•Ensured that all duties are carried out to the highest possible standard, and in accordance with current quality initiatives within the area of work.
•Performed any other duties which might have been required from time to time.
HIGH SCHOOL DIPLOMA
2 YEARS IN COLLEGE
•CPR CERTIFICATION, FIRST AID
•CNA/GNA (Certified Nursing Assistant)
•Certified Dental Assistance
Computer Operating Systems: 2000/XP/2003
Software: Microsoft Office Suite (Excel-Word-PowerPoint-Access-Outlook)
Hardware: PC-HP-COMPAQ-DELL-E-MACHINE- POINT OF SALE SYSTEM (POS).
Typing: (35 wpm).
References available upon request