Customer Service Quality Assurance

RESUME

Personal Contact Information:

Brenda J. Fazzini Phone: 210-***-****

**** ******** **** *****: ********@*****.***

San Antonio, Texas 78254

OBJECTIVE

I would love to work in an enviroment where I can keep learning and keep growing, where

my skills can be useful and fruitful to my employer. A place where I can continue to succeed

and be challenged.

EXPERIENCE:

Connexion Point

Sept 16, 2013 to 3/10/2014

Healthcare customer Service for Coventry healthcare Medicare Advantage Plans. Incomming calls

to Enroll Medicare Members in Part C Advantage plans or Part D Prescription drug plans.

Explaning and Advising Medicare beneficiaries of Medicare rules . Understanding of Medicare

and Medicaid for different states. Connexion Point Supervisor: Ebony Loving

Phone:

Stone Oak Family Doctor’s P.A

May 21, 2012 to present

Biller/collector All insurance’s self pay. Keep A/R updated monthly, patient calls and inquires,

calling patient for payments due, insurance info, adding insurance and obtaining Benefits & Elig

and sending to secondary & Tirciary insurance co’s for billing. Statements, etc. Use online for

much insurance information, calling Cust Srvce to check status of claims, corrected claims billing.

Human Resources: Insperity: 800-***-****

Texas MedClinic

Sept 6, 2011 to May 1, 2012

Managed Care Collections Lead. Maintain Claims streamline process of electronic and manual

claims submission, collection, appeals and corrected claims. Call insurance co’s for Benefits &

Eligibility for patients at all of our clinics in Round Rock, Austin, New Braunfels and San Antonio.

Timely Statements for patients, collecting balances over the phone and sending past due accounts

to collections. Use online sites such as Availity.com and UHC, etc. for B&E and claims status.

Calling insurance co’s for claim status, etc.

Supervisor is ; Mgr is : Carmen Garza 210-***-****

Kinetic Concepts, Inc : (Feb 2002 - May 2011) 800-***-****

Titles: CSR III, COPA, Quality Assurance Rep.

C.O.P.A = (Coordination of Patient Administration) contact with Physicians, Case Mgrs, and

patients regarding Neg Pres Wound VAC system and support surfaces. Contact with sales and

clinical field reps for KCI.

Quality Assurance rep: Check daily work output by KCI reps for Wound Tracking: reporting to

supervisor of teams and suggest training or opportunities for learning.

CSR II and Order Intake: contact patient, case mgrs, physicians, and KCI sales and Clinical field

teams to obtain correct info including insurance, prescriptions for Wound VAC or support surfaces

orders. Obtaining Benefits and Eligibility for our products, and authorization for use of those

products. Completing orders in 2 different systems releasing product for delivery, and arranging

delivery. Helping patient understand insurance benefits regarding DME. Handled all insurance

types, including Medicare and Medicaid, & Workers Compensation. Traveled to VA Beach, VA for

Pilot programs and testing of procedures. Also worked in Quality Assurance dept for 2 yrs here

keeping track of appropriate wound progress documentation, measurements, etc.

I had much success at KCI in different Areas, because I enjoyed growing and learning.

HUMANA INS. CO.: (May 1999 to Nov 2001)

Customer service representative: Benefits and Eligibility for Members, changing PCP’s and issuing

I.D Cards, Claims Status and one and one with patients in person for Medicare HMO Risk

products questions and sign up. Traveled to Green Bay, WI for meetings

First Care, Ins. Co: (Jan 1997 to May 1999)

Appeals representative: Speaking to Members regarding claims appeals, helping to obtain needed

info from PPO networks and providers to write up for Appeals Adjuster for possible Overturn of

denied claims. Traveled to Austin, TX for training and meetings.

Humana Ins. Co.: (1998 to 1999)

CSR: all aspects of Customer service to Both Members and provider offices, and Claims adjuster,

processing claims in-between phone calls.

The Principal Financial Group: (1996 to 1998)

CSR: Processing PPO claims, Claims trouble-shooting.

Endocrine Associates of Dallas: (1995 - 1996)

Billing claims, Insurance B&E, front desk appointments, bank runs, personal errands for doctors.

The Prudential Ins. Co: (1992 - 1995)

CSR, Claims processing, Provider Relations:

All aspects of customer service to Members and providers, claims processing, and signing up

physicians for HMO and PPO products which required travel.

Surgical Associates of Dallas: (1990 - 1993)

Billing, Customer Service phones and Benefits and Eligibility checks for patient insurance.

Personal errands for doctors.

Bankers Commercial Life ins. Co: (1988-1990)

Claims Adjuster: process claims by diagnosis, phone calls from patients/members

Some Router work also.

EDUCATION

High School graduate : W.B. Ray High School. Corpus Christi, TEXAS 1980

Basic Education, Athlete, member of the Band.

Del Mar College: C.C Texas: Major Surgical Technology Minor Physical Education

Did not finish.

Employer Driven Education:

Team building, Objectives for Supervisors and Managers, Medical Terminology, The Anatomy and

Physiology of Wounds and Wound healing. H.I.P.P.A compliancy, CPR, Basic First aid, Heart

Saver A.E.D (difibulator) ( I have had to perform 2 Himlich manuvers 2 times in 9 yrs at one of my

Co-Workers, and once on one of my daughters)

**Texas General Lines Agent Life, Accident, Health & HMO License # 1895200 ***

Awards: Many High Five awards @ KCI from both field EE’s and co-workers for excellence in

service or going beyond my duties to help.

I can operate: Printers, Faxes, Phones, PC, windows, Excel, other programs. Had license for CPR

and for DiFib and basic First Aid. (need to re-new)

INTERESTS

I am a very active person, I have my husband and our 3 daughters do a lot together. I love to play

Tennis and I love to Garden.

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