Customer Service Medical
Resume:
Ray Hurndon
Dallas, Texas *****
*********@*****.***
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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