Customer Service Representative
Resume:
Anne E. Candela
*** ******** *****, ******** **** 44095
Customer Service * Data Entry * Microsoft Word/Excel * Medical Billing * Physician Billing *
Insurance Follow Up * Registration * Appointments * Coordination of Benefits * Catastrophic First
Notice of Loss Representative
Skills and Training
Currently being trained on Catastrophic Weather Related Customer Service relations.
Over 20 years administrative experience – in bound calls, out bound calls, superior data entry skills, 10-
key by touch, proficient typist, filing and excellent attention to detail
Over 15 years in the healthcare industry
Proficient in both Hospital Billing and Professional Billing
Extensive Customer Service Skills
Knowledge and Use of the Epic system, HBO system, SMS system and Meditech. Electronic Medical
Records.
Knowledge and Use of Navinet, Mits and Availity as well as several other internet sites
Professional Experience
April 2014 – Current, Catastrophic Management Solutions: Customer Service Representative
In training to assist All State Insurance policy holders when catastrophic weather related issues arise. The
customer service representative is the first person a policy holder reaches when a catastrophe has changed
their life. As a customer service representative the responsibility includes beginning the claim process
which includes verification of coverage, policy type, in some cases advising of benefit coverage,
assigning a claims adjuster and setting up appointments as needed depending on catastrophic losses. This
is a contingency position – the work hours are available when or if a catastrophic event occurs.
August 2013 – February 2014, Independent Physician Solutions: Patient Account Representative
Entered hand written professional (doctor) billing services and diagnosis codes into the billing system
including creating a patient demographic for new patients. Followed up on submitted claims including
but not limited to working rejected claims correcting any errors in an effort to obtain prompt payment
from the insurance carrier.
June 2013 – July 2013, Avery Dennison, through Alijon Professional Services: Data Entry
Specialist
This was temporary position to assist the forewoman in creating a complex spread sheet that would hold
the formulas(s) for routine and special order (jobs). This was an alpha numeric series of specs that were
entered in to excel and to be used to create a “recipe” for a specific job. Once all this information was
entered into the computer system the machine operators merely had to enter the job code and all the specs
for that specific job was populated on to the computer system that ran the machine. I had to be very
detailed with this as anything that was entered wrong would ruin the recipe and ruin the job.
Caregiver for my Mom
July 2011 – February 2013, When it became clear that my mom could no longer be home alone (she was
living with me) I resigned from the Cleveland Clinic to care for her as a permanent caregiver. She had
dementia and at the time was 91 years old.
The Cleveland Clinic
Health Unit Coordinator - (2009-2011), Account Rep I - (2005-2009), Hospital Billing - (1999-
2005), Customer Service Representative - (1998-1999)
Health Unit Coordinator: Worked on the cardiac care floor at night assisting the nurses and doctors with
administrative duties such as putting together patient charts, answering phones, arranging for transfer of
patients to ICU, arranging the transfer of a patient from a sometimes out of state facility to the Cleveland
Clinic and answering patient call lights.
Account Rep I/Neurological Institute: Responsible for the Denial Data Base resolving all claims that
were submitted and returned from the insurance carrier for various reasons. Updated Patient Registration,
precertification and authorization of Mental Health Services. Assisting the coding and reimbursement
specialist as needed. Maintained the VIP patient appointments, billing and copayments using discretion
as these patients were public figures, sport’s figures or high profile business men/women.
Hospital Billing: Reviewed all claims that were held for editing purposes. Reviewed and had claims
corrected so that a clean claim would be submitted to the patient’s insurance carrier. Followed up with
insurance carriers on unpaid claims, provided documentation when required. Contacted patients with
regards to insurance information including but not limited to Workers Compensation information. Placed
calls to both insurance carriers and patient’s as needed. Excellent understanding of coordination of
benefits specifically Medicare Secondary Payer.
Customer Service: Received inbound calls from patients, insurance companies and employers. This
resulted in an excellent knowledge of the hospital and professional side of the clinic’s billing system.
Resolved all patient issues and initiated patient refunds as well as insurance refunds due to over
payments.
References upon Request
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