Customer Service Medical
Resume:
LISA A. EZEKIEL
Apt G
Winston-Salem, NC
CAREER SUMMARY
An individual who is self-disciplined and motivated with strong
communication skills, experience in (medical) customer service, and a focus
on the future. A team player, but definitely a self-starter.
EMPLOYMENT HISTORY
ADVANCED HOME CARE, High Point, NC 9/2002-6/2009
Triad Physician Services (Held Revenue)
The Patient Account Representative II (PAR II) position is responsible for
obtaining accurate medical documentation, distributing and retrieving
Certificates of Medical Necessity (CMNs), Prior Authorizations (PAs), and
Written Confirmation of Verbal Orders (WCVOs) to improve the number of
billing days revenue remains in a "held" status due to no payment from the
insurance companies. This position works closely with physicians and the
physician's staff, requires considerable knowledge of medical terminology,
and a complete understanding of insurance guidelines and medical coding.
Triad Respiratory Support/Oxygen Care
Duties include providing oxygen patients with stationary, portable, and
traveling oxygen equipment, scheduling daily appointments for Respiratory
Technicians, and routing daily deliveries for oxygen drivers. The position
is also responsible for scheduling equipment maintenance and establishing
new patients on a bi-weekly or monthly call schedule to manage the volume
of scheduled and non-scheduled deliveries. Duties also include
implementing the STOP (Safe Transition of the Oxygen Patient) when patients
are discharged from oxygen services or equipment is no longer required.
The position requires a positive attitude, excellent communication skills,
effective time management, and focus on details.
Reimbursement/Billing Department
This Patient Account Representative (PAR) position is responsible for Blue
Cross/Blue Shield of North Carolina (BCBS/NC) Indemnity, HMO and PPO health
care plans. The reimbursement PAR requires a broad range of
responsibilities from the collection of patient/commercial accounts,
account settlement, medical documentation, billing and customer billing
inquiries. This position requires the ability to work independently, while
making effective use of work time to accomplish individual, team, and
departmental goals.
Duties include keying and submitting claims (HCFA) to bill durable medical
equipment and home infusion therapy, checking claim status, auditing
accounts, and requesting reprocessing of claims while building and
maintaining a professional rapport with BCBS representatives. This
position requires a "can do" attitude and the ability to use sound judgment
to mesh AHC's philosophy with excellent customer service and communication
skills.
Qualifying Orders Processor (QOP)
This Patient Account Representative (PAR) has a broad range of
responsibilities including referral intake and coordination, order entry,
order qualification, verification/authorization, and obtaining medical
documentation for durable medical equipment. Additional responsibilities
include compiling and reviewing claims billed to Medicare, Medicaid,
Contracted, and Other Third Party (OTP) payors. The position requires
knowledge of collection of patient/commercial accounts, account
settlements, billing, and customer billing inquiry. The position also
requires exhibiting courtesy, respect and professionalism at all times.
LISA A. EZEKIEL
Page 2
EMPLOYMENT HISTORY - continued
Qualifying Orders Processor (QOP)
( Average 40-45 verifications and 10-12 authorizations per week.
( I was the only representative who managed oxygen patients in
Asheville, NC
on the 4357 Oxygen Program.
AETNA US HEALTHCARE, INC., High Point, NC 1/1999-8/2002
Customer Service Professional
Responsible for assisting and educating managed choice (MC) and traditional
choice/open choice members with individual/group health care plans and
medical benefits (i.e. patients' rights, responsibilities and procedures),
while providing quality customer service to employees/employers,
dependents, physicians, and various health care officials. This position
requires extensive training and knowledge of the medical field, medical
terminology, CPT codes, diagnostic codes, and ICD-9 coding.
Duties include assisting participating providers and non-participating
providers (physicians, surgical centers, etc.) with member eligibility
status and medical claim information. Also responsible for performing
primary care physician (PCP) changes, updating provider demographics, and
processing medical claims via OCR/NEIC claim systems.
( Average individual call volume 92-105 calls daily, with an
average handle
time of 2 minutes.
( Demonstrates 100% follow-up/follow-through.
This position requires the ability to perform various tasks simultaneously
and maintain the highest levels of teamwork and professionalism.
EDUCATION
Hampton University - Hampton, VA
Winston-Salem State University - Winston-Salem, NC
University of Phoenix (online)
B. S. Elementary Education (K-6)
Anticipated graduation Fall 2014
GPA 3.77
ORGANIZATIONS
2013-2014 Volunteer, Wentz United Church of Christ Food Bank - Winston-
Salem, NC
2012-2013 Math Tutor (Fourth Grade) - Abess Park Elementary, Jacksonville,
FL
2010-2013 Upward Basketball Team Parent/Coordinator - Kernan Boulevard
Baptist Church, Jacksonville, FL
2009-2013 Box Tops for Education Coordinator - Abess Park Elementary,
Jacksonville, FL
2009-2013 PTA Member, Chaperone, and Parent Volunteer - Abess Park
Elementary, Jacksonville, FL
2009-2013 Reading Tutor (First/Second Grade) - Abess Park Elementary,
Jacksonville, FL
2008-2009 Volunteer, United Metropolitan Missionary Baptist Church Youth
Ushers - Winston-Salem, NC
2007-2009 PTA Member, Chaperone, and Parent Volunteer - Ashley IB
Elementary, Winston-Salem, NC
REFERENCES
Furnished upon request
Contact this candidate