Customer Service Insurance
Resume:
T YSHUNDA HODGE
Nashville, TN ****8
Phone: 615-***-****
E mail: acbf5w@r.postjobfree.com
PROFESSIONAL SUMMARY:
Excellent communication and leadership skills
Ten (10) plus years of customer service experience
Seven (7) years of healthcare experience
TECHNICAL SKILLS:
Software:
MS Office
AppXtender
Ingenix
Invision
Zirmed
Advantx
McKesson/HBOC Star
DataServ
EDM
CAREER HISTORY:
United Surgical Partners Inc Collector
February 2013 August 2013
Responsible for follow up on delinquent claims
Interpret a managed care, Medicare, and Medicaid contracts
Determine appropriate reimbursement rates
Identify accounts that have been either under or over paid
Appeal and dispute claims processed incorrectly
Request auth for Ambulatory surgery center
Assists patients with account inquires and collect money due on accounts
Sets up payment plans for patients with high balances
Cymetrix – Patient Account Representative
April 2011 February 2013
Responsible for the review and follow up of outstanding accounts
Contact insurance companies for collection of outstanding claims
Resolve outstanding accounts
Utilize/review reports to identify reimbursement problems with insurance companies
Compose letters to insurance companies/patients to resolve reimbursement problems
Telephone insurance companies to resolve contract issues regarding rates of payment
Review bad address reports, returned statements and utilize resources to locate correct information
The Jacobson Group – Telecommuter: Health Claims Rep (contract)
November 2010 April 2011
Provide excellent customer service
Constantly meet established productivity, schedule adherence, and quality standards
Respond to complex provider calls
Resolve provider inquiries which included:
Benefit and Eligibility information
Claim issues
Physician assignments
Authorization
Explanation of Benefits (EOB)
HealthSpring Provider Service Rep
July 2007 – May 2010
Train new hires
Intermittent Team Lead
Recommend strategies to improve Provider Services team
Respond to providers and vendors, regarding health plan benefits, claims status, authorization statuses, etc…
Record provider inquiries regarding benefits, claims issues, medical authorizations, etc…
Respond to provider escalations
Maintain follow up files and call inquiry accounts
Ran daily MSM reports
Participates in staff and team meetings
Handle TTY Line calls daily
Perform miscellaneous duties as assigned
Caremark Inc Customer Service Rep III
August 2005 – June 2007
Assisted participants with prescription: refills, mail orders, prior authorizations, retail help
Served as a primary resource in handling Participant inbound and outbound contacts for those assigned to Adopt a
Participant Program
Served as primary interface with all Participants within designated call center
Documented all inbound and outbound contacts within Participant records and tracking tools
Monitored progress of Participant satisfaction with issues, resolutions, and delivery of service
Analyzed information and provide suggestions for process improvement
Served as backup to the Client Liaison Coordinator
Resolved eligibility issues in accordance with standard operating procedures
Assisted with Medicare Rx Benefit questions
Amtemps: Tenncare Partners Advocacy Line Advocacy Specialists
April 2005 – July 2005
Called Tenncare Enrollees and verify their address
Explained cancellation letters to Tenncare Enrollees
Explained how they can applying for Medicaid, to try and prevent losing Tenncare
Provided information on getting, keeping, and using Tenncare services
Sprint PCS Business Services Representative
September 2002 to June 2004
Accepted incoming calls from PCS business and consumer customers
Processed payments
Accessed multi line business accounts
Amended account information
Troubleshoot billing issues
Troubleshoot equipment issues
Ordered and shipped equipment to customers
Educated customers of equipment and its features
Activated new accounts
Education:
South Suburban 09/95 – 06/97
Major: Business Administration
Minor: Psychology
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