Customer Service Medical

Pamela Collier

*** ******* **, ********, ** *****, 678-***-****

*************@*****.***

SUMMARY OF SKILLS:

1. 25 years of Medical Service experience

2. 4+ years of Customer Support experience in heavy inbound call center

environment

3. Triage phone calls with clear precise communication and writing skills

4. Proficient in MSOffice Suite-Word, Excel, Access, PowerPoint, and

Outlook, Ten-Key proficient; Typing 45 wpm

5. 7 + years EDI, Q-Care, SQL-Query, & CICS; + years of Unix scripting

language.

6. Experience with computerized claims billing, light bookkeeping,

accounting, accounts receivables, data entry, customer service

skills, and provider relations skills

7. Strong capabilities with analyzing and researching claim processing,

claims adjustment, physician and hospital; ability to develop

innovative solutions quickly

8. Exceptional team player with a passionate attitude when taking on new

projects and providing team guidance; excellent troubleshooting

skills, able to learn quickly and work independently

9. Recognized as employee of the month for 11 consecutive months for

keeping above average processing record

10. Reduced Medicare/Medicaid claims returns by 95%

EXPERIENCE:

United Healthcare, Atlanta, GA (2007 - present) Customer Care

Professional

Nationally Renowned Healthcare Services

. Provide customer service by answering inbound calls regarding

claims billing, benefit information, communicate with members,

providers & document all call information electronically

. Act as the liaison between the case coordinator for assessment

based on patient information and care/services requested

. Complete intake screenings, which include obtaining and documenting

in the medical management system all patient, provider, demographic

and treatment information

. Determine pre-certification of services requested based upon policy

and benefit protocols, correct service center and claims

adjustments per edit request

. Manage legal documentation according to HIPPA guidelines; cross

train intake and care advocates on privacy policy

Sratose -formerly Coalition America, Atlanta, GA (2005 - 2007) Network

Re-Pricing Analyst

Healthcare Savings Company.

. Reviewed validated member and providers claims billing using CPT,

HCPCS, and ICD9 on claims

. Processed claims via spreadsheet report through SQL Query

. Investigated and achieved discounts on all claims within guidelines

set by Data Management Team

. Able to work with little direction and self motivated

Blue Cross Blue Shield of Georgia, Atlanta, GA (2000 - 2004) Claims

Associate

Health Insurance Provider

. Analyzed and adjudicated claims for CPT and ICD9 codes and other

claims related data

. Researched and performed special projects, ho2-egb reports with

complex claims pertaining product applications

. Coded, keyed and processed all medical and dental claims according

to RTE, policy guidelines

. Audited high dollar claims for correct reimbursement of contractual

benefits and arrangements

. Evaluated system issues and claims edits to identify root

cause/resolution

. Structured, coordinated, and facilitated cross training to less

experienced analysts

EDUCATION:

University of Phoenix, Atlanta, GA

Bachelor of Science in Business, anticipated graduation 2014

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