Customer Service Data Entry

SONIA FRANCIS

*** ** **** ****** ***#* Oakland Park, FL 33334 Cell: 786-***-****

OBJECTIVE:

To maximize my career in a professional setting that will permit me to cultivate as a leader with

an organization that encourages personnel development and promote professional behavior

QUALIFICATIONS:

Proficient in performing routine patient screening, medical office setting good communications skills and,

Customer service skills, Knowledge of medical billing and third-party reimbursement claims. Possess strong analytical and organizational skills as well as excellent interpersonal skills, phone manners, and

Office etiquette, Manage Care and Medical insurance experience, Medicare and Medicaid experience

Software: MSWORD, Excel, Microsoft, WordPerfect, Power Point, GUI System, Epic, MED3000, HIPPA,

CPR, OSHA, HIV/AIDS, Assesses patient care, Intake coordinator, Ensure compliance with quality patient

Management and satisfaction, medical terminology, CPT/ICD codes/Insurance, sales and Customer Service

Work History:

Community Care Plan, Sunrise FL

Member Service Coordinator; 2016-2019

Responsibilities includes assist providers and clients with Medicaid HMO, enrollment and disenrollment

Process, which include inbound calls from Medicaid choice and forwarding all required documents and

Entering patient information into customer system, which included use of computer and other systems

Handling patient referral sources, ad Communicating with provider and Medicaid members and/ or

Prior authorization request, also includes servicing claims calls for payments, denials and EOBs request

Work close with Department of Children and Family, Hospitals, Doctors offices and other insurance

Companies, with problem solving, verify insurance, billing, faxes, emails and other medical issue Duties also includes, assisting Medicaid members completing Health Administration Forms over the

Phone, which involve, screening members with last and future follow up with their doctor visit, other

Other duties include educate members with understanding use of Medical Service Developing the

Knowledge of customer satisfaction and loyalty, and Assist Credentialing Department with phone calls from Nurses and Hospitals and entering information into computer system, also Assist the Population

Health department with special projects on reporting information on member health to AHA, take

Ownership of each call from members, follow up with members and providers complaints and sales

Convey Health Solution/Cigna Healthcare, Sunrise, FL

Member Service Representative, 2014-2016

Processed enrollment application for low income subsidy members through Medicare/Medicaid

Receive inbound and outbound calls, pertaining to drug coverage, drug look up claims and billing

Performing excel, data entry, filing, reviewing member s files, emailing, faxes and collect payments

Responsibility also include solving members complaints, grievance, and assist with esculation calls

Checking insurances coverage/benefits with coverage and completing coverage of benefits surveys

Concentra Medical Healthcare, Ft. Lauderdale, FL

Medical Front Office, 2010 –2012

Receive and route incoming calls; responsible for scheduling appointments and greet patients

File paper work, document charts prepare for next day of service and packaging on daily bases

Process Workers Compensation Claims, Accident claims, chartings and patient check in and out

Respond to patient complaint, problem and request, attend patient room and offer therapy service

Prepared and faxed patients’ referral to insurance company, sales, inbound/outbound calls

Responsible for obtaining authorization, spread sheet, problem solve, data entry and multi task

Perform medical clearance processing, billing and fill out documents for clients and patients

Social Service Coordinators Healthcare, Miami Lakes, FL

Intake Specialist/Case Management, [2002 – 2008]

Processed applicants to the state to assist with Medicare/Medicaid HMO members to get the reimbursement of Medicare part B premium and part D prescription drugs and service inbound and outbound calls which also include, follow company protocol, convenience member to apply for different government benefits, includes making a daily quota per day, meeting monthly goals and productivity,

Performed data entry, maintained files, utilized spread sheet health insurance sales and file documents

Responsible for emailing, faxing and mailing out applications; verified Medicare coverage and billing

EDUCATION:

Everest, Ft. Lauderdale, FL

Medical Assistant Diploma, [2009]

Miami Lakes Technical Institute, Miami, FL

Computer Programming Certificate, [1997]

Miami Dade Community College, Miami, FL

Associate Degree in Travel and Tourism Management, [1992]

References furnished upon request

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