Customer Service Medical
Resume:
BRENDA HUGHES
**** **** ***** **** • Houston, TX 77053 • ***************@*******.*** • 281-***-****,
INSURANCE /MEDICALCOLLECTIONS
DATA ENTRY/ CUSTOMER/SERVICE
SUMMARY OF QUALIFICATIONS
• Maximize resources to achieve client satisfaction and increased productivity, meet deadlines and
goals.
• Experienced with medical claims collections, for commercial and federal accounts
• Proven success interacting with patients, physicians, insurance companies in a customer service setting
• Knowledge of ICD-9 AND CPT-4 codes
• Computer skills include: HBOC, CUBS, IDX, Epic, Facet, E-Clinical
• Microsoft Word, Excel, Outlook and Access, Typing 45(wpm)
Core Competencies
Insuran ICD- Persistence
ce 9 /Discipline
Custom CPT Organizati
er -4 on
Service Anal Posting
Collecti ytica
ons l
Skill
s
Com
muni
catio
n
EXPERIENCE
AR COLLECTION 2010 –present
CARLTON STAFFING Houston, TX
• Collect on medical claims from commercial insurance and government payers
• Interacted with physicians, patients, medical records to clarify coding and billing issues
• Call payers to verify receipt and status of the claim, and negotiate payments
• Document result on to spreadsheet, amount paid, check number, and date sent
• Review Explanation of benefits to determine if claim paid correctly via contract
• Review medical records, update demographics, charges and rebill claims
• Interacted with clients and businesses via telephone to answer billing inquiries
A/R COMMERCIAL COLLECTIONS/FOLLOW-UP 2000 –2004, 2009
ON ASSIGNMENT STAFFING Houston, TX
• Follow-up with insurance companies via outbound telephone to collect on unpaid accounts
• Entered data and documented results onto Excel Spreadsheet
• Answer clients phone calls and research account to resolve problems
• Reviewed explanation of benefits for payments, re-bill claims, filed appeals, and verified benefits.
• Reviewed and paid UB92 and HCFA health HMO, PPO, POS claims.
A/R COMMERCIAL COLLECTIONS/FOLLOW-UP 2005 –2006
MD ANDERSON CANCER CENTER Houston, TX
• conducted insurance follow-up via telephone for accuracy and efficiency of unpaid bills
• Requested status updates, re-billed, and documented accounts via notes and Excel spreadsheet
• Answer clients phone calls and research account to resolve problems
• Review and correct billing errors
CLAIMS EXAMINER 1998 - 2000
PRUDENTIAL HEALTHCARE Houston, TX
• Paid electronic and paper UB92 and HCFA health HMO, PPO, POS claims.
CUSTOMER SERVICE REPRESENTATIVE 1995 - 1997
CIGNA HEALTHCARE Houston, TX
• Educated clients via telephone on medical, dental, vision, and Cobra plans.
• Answered customer questions regarding billing inquiries, processed new applications and updated
new selections
• Optimized processes, advising clients on limits, coverage.
• Managed data input, selections, and assisting with open enrollment.
SHAREHOLDER SERVICES REPRESENTATIVE/INVESTOR SERVICES 1992 - 1995
BANK OF NEW YORK Houston, TX
• Received inbound calls from clientele and customer in regards to dividends, stocks, and share
balances
• Educated clients regarding banking and trust requirement and processed applications for new stock
and liquidation
EDUCATION AND TRAINING
CERTIFICATE- MEDICAL BILLING AND CODING Scranton, PA
PENN FOSTER SCHOOL
UNDERGRADUATE COURSEWORK - SOCIOLOGY Brenham, TX
BLINN COLLEGE -2yrs
COURSEWORK - RISK MANAGEMENT Houston, TX
HOUSTON COMMUNITY COLLEGE
REFERENCES
Excellent references will be provided upon request.
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