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Customer Service Medical

Location:
Dallas, TX
Salary:
50,000
Posted:
August 24, 2019

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Resume:

Ray Hurndon

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

Dallas, Texas *****

469-***-****

ac952x@r.postjobfree.com

OBJECTIVE

Accomplished “Healthcare Administration Professional” with experience planning, directing, and coordinating medical services for hospitals, as well as call centers. Strong, award-winning leadership capabilities. Focused and dedicated to delivering high quality service to patients.

EDUCATION

Texas A&M University-Commerce Commerce, Texas

(1994-1996)

Seagoville High School Seagoville, Texas

(1990-1994)

High School Diploma Received

SUMMARY

Over 10 years’ experience in call center customer service and case management. Including inbound healthcare ACD call center environments, distribution services, and telecommunications call centers.

Experienced leader possessing analytical and negotiation skills with strong attention to detail. Dedicated and driven professional with the ability

to interpret methods and procedures in an environment characterized by high

performance and quality standards.

EXPERIENCE

First Care Health Plans

Claims Supervisor (09/01/2018-02/18/2019)

Supervised and oversaw the day-to-day workflow operations for a team of 21 claims examiners to ensure employees' production and standards were met and claims were processed timely

Planned, organized and prioritized duties and assignments along with training while simultaneously meeting management duties and expectations

Maintained daily communication with staff, scheduled telephonic conferences to perform one-on-one performance and progress feedback

Tracked and monitored staff's daily attendance for payroll and accountability

Evaluated staff and cross-trained examiners on processing other types of claims to include: dialysis, hospital, ambulatory service center and ambulance claims

Conifer Healthcare

Lead Rep/A/R/Credit Analyst (05/14/2014- 08/25/2018)

Responsible for providing assistance, coaching and training to staff members, including new hires

Support and assist the Team, the Supervisor and Management with complex inventory and issue resolution

Assist in special projects as assigned my management, including acting as a point of contact for internal operational questions

Review the account information and necessary system applications to determine the next appropriate work activity

Provide enhanced training and assist staff with techniques to increase production, quality and collections.

Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions.

Review the account information and necessary system applications to determine the next appropriate work activity. Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed. Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.

Participate and attend meetings, training seminars and in-services to develop job knowledge. Participate in the monthly, quarterly and annual performance evaluation process with their Supervisor. Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system or escalated account issues

United Healthcare

Provider Phone Representative (7/2010-3/2014)

Answer inbound calls from healthcare providers

Explain all medical benefits to inbound callers including but not limited to preventative care, maternity, office visits, inpatient and outpatient care, labs, x-rays, and diagnostics, physical therapy, DME, etc.

Review healthcare claim denials, payments, and refund requests with inbound callers

Maintain strict daily quality and performance standards

PFS Web

Claims/Sales Support Representative (7/2007-7/2010)

Manage and process purchase order case loads for assigned clients

Research claims regarding refunds, damaged product, etc.

Process and refund payments via credit card for clients and provide assistance to teammates as needed.

Excel Telecommunications

Customer Service-Team Lead (11/2002 - 6/2007)

Received escalated and executive calls from customers concerning telecommunication orders, problems, and complaints

Train and assist team members with call center products and procedures

Optel Telecommunications

Call Center Team Lead (2/1999 - 10/2002)

Receive and respond to incoming calls from customers to resolve any account issues.

Receive calls from agents to determine whether a potential customer was eligible for local service.

Train and assist team members with on products, policies, and procedures

Monitor and evaluate calls of team members to make sure all quality and performance standards are being met

QUALIFICATIONS

Literate in all Windows Applications, Internet, PowerPoint, Excel, and Word

Type 45-50 WPM

Acquainted with call center environment strict quality, attendance and performance policies and procedures

Familiar with ICD-9, CPT Codes, medical terminology, HIPAA guidelines, and claims processing requirements

Proficient in IEX, ISET, and UNET operational systems, NextGen, Kareo, Crystal, Medi Touch, Med Assets, Citrix, Paragon, Epremis, Cerner, Ace, Epic, All Scripts, MDX, Cirius, Availity, Passport



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