Customer Service Medical

Audrey Henderson

Richardson, TX

**********@*****.*** - 469-***-****

WORK EXPERIENCE

Revenue Cycle Speciialist

CCS Medical - Richardson, TX - September 2012 to June 2013

Responsibilities

Worked individual portfolio of accounts from CCS Medical billing/collection system

• Assessed insurance reimbursement for individual supplies to ensure maximum reimbursement

• Verified that all appropriate supporting documentation were obtained prior to shipment and/or prior to billing

• Audited configuration of supplies based on supporting documentation, formulary requirements and

manufacturer compatibility

• Identified problems or improvements within own area, developed resourceful and alternative solutions for

work improvement or problem solution

• Researched and followed up on all correspondence associated with assigned accounts, including EOB’s and

documentation letters, and generate correspondence requesting required information, when necessary

• Initiated appeals and ensured all required documentation was submitted in the appeals process.

• Researched all denials and followed up as necessary

• Received inbound and placed outbound calls to/from insurance companies and patients to collect outstanding

funds•

• Reduced delinquent accounts and achieving maximum collections from all sources

• Produced reports identifying trends or problem carriers, and identify areas of concern and present ideas to

correct or prevent future issues

• Analyzed and corrected accounts receivable problems

• Documented all activities as completely as possible.

• Achieved productivity goals based on accounts touched, dollars collected, and aging period

• Maintained a high degree of confidentiality at all times due to access to sensitive

Skills Used

Pims

Excel Spreadsheet

Microsft Outlook

Windows XP

lOTUS Notes

Participant Service Representative

Conexis - Dallas, TX - September 2011 to March 2012

Responsibilities

Educated and informed the caller about COBRA and Direct Billing or about Flexible Spending Account

inquiries.

• Communicated clearly and professionally with account management, or required departments, via case

documentation, to resolve participant issues.

• Participated in and maintained a quality service culture within the Customer Service organization.

Skills Used

Complink Sytem

Sharepoint System

Client Portal

Provider Relations Representative

HMS - Irving, TX - September 2010 to March 2011

Responsibilities

Responsible for recovering payments from commercial insurance carriers who should have paid primary to

the Medicaid agency.

• Conferred with carriers by telephone and used Web sites to determine member eligibility and claim status.

• Assessed denials pursued appeals and closed claims when appropriate.

• Updated case management system with proper noting of actions and appeal/denial information.

• Responded to carrier telephone, fax and e-mail inquiries regarding outstanding claims.

• Sorted and filed correspondence.

• Mailed form letters to carriers to affect payment of outstanding claims.

• Contacted providers to obtain additional information and/or documentation to resolve unpaid claims.

• Managed a weekly aging report.

• Responsible for achieving high recoveries against a portfolio of claims.

• Worked with document imaging system for archival purposes.

• Ensured that payers adhere to laws regarding timely filing of claims.

• Pursued each outstanding account to reach maximum reimbursement by working with subject matter experts

to resolve challenging claims.

Skills Used

E-Center

Provider Portal

Customer Service Advocate

Aerotek - Plano, TX - April 2010 to July 2010

Responsibilities

Responded to customer accounts/or vendor inquiries related to AAFES Credit Program & Fair Credit Reporting

Act and Direct Marketing& Catalog Operations.

• Researched various on-line computer systems, and to the extent possible,

• Provided immediate response to customers, command, vendors, and store associates

Reimbursement Specialist

Aerotek - Plano, TX - February 2010 to April 2010

Responsibilities

Submitted Timely, accurate submission of invoices to the responsible payer for services and products provided;

• Evaluated payments received and application to the patient account;

• Followed -up with responsible parties to ensure the receipt of timely, accurate payments.

Medical AR Followup Rep

GE Healthcare - Addison, TX - May 2008 to January 2009

Responsibilities

Worked on three accounts Aetna, Kaiser, & Cigna

• Requested medical records from Practice Administrators on Kaiser Insurance worked out of Excel

spreadsheet.

• Checked status of claims, appeals, correspondence, eligibility & benefits, corresponded via telephone to

insurance companies and also via fax.

• Called insured verifying eligibility and coverage.

• Updated insurance information in the IDX system.

• Did charge corrections, billing, processing etc, made numerous of outbound calls to insurance companies

discussing claim payments, adjustments, refunds, billing issues, coding problems, timely filing, deadlines etc

Customer Care Advocate

Perot Systems - Dallas, TX - February 2006 to January 2008

Responsibilities

Answered inbound calls regarding claim issues, benefits, eligibility, coverage determination, recoupments,

stop pays reissues, premiums, earnings, etc

• Assisted members with billing questions and overall claim status and final determinations.

• Corresponded with providers via email and fax HCFA' S & ub92's that were in the system

• Handled outbound calls to providers & members on claim status or any updates regarding claims and

completed forms.

• Mailed out Cob letters & Eobs upon request of provider or participant.

Skills Used

SAG

Workmens Compensation Auditor

Concentra - Carrolton, TX - February 2004 to December 2005

Responsibilities

Investigated Workers Compensation Medical Only cases to the extent necessary to determine compensability

• Reserved claims within authority based on Cambridge quality standards and/or client requirements

• Resolved medical bill errors utilizing knowledge of workers' compensation fee schedules.

• Applied PPO information when necessary, verified pre-certification, reviewed medical claims for proper

compliance

• Processed medical bills using CPT-coding as well as ICD-9 coding

• Utilized company databases and methodology to negotiate claims, provided clear, as well as up to date,

case note documentation.

Skills Used

Cambridge only

ICD-9

Medical Coding

TX oNLY cLAIMS

Customer Care Advocate

Blue Cross Blue Shield - Richardson, TX - December 2001 to February 2003

Responsibilities

Resolved and responded to various customer inquiries, via telephone and correspondence regarding claim

issues within established production and quality standards.

• Promptly and accurately answered incoming calls or written requests for information regarding members and

provider.

• Composed new and routine correspondence to answer member inquiries that required a written response

• Coordinated with other departments to ensure timely and appropriate responses.

• Expedited and resolved complex issues and corrected claim adjustments.

• Provided education on the Blue Shield product, given accurate information and updates to policies and

procedures, improving overall customer satisfaction in the process

• Expedited and resolved complex issues and corrected claim adjustments.

Skills Used

Blue Chip

Blue Card

Nasco

EDUCATION

Certification in Small Business Ownership

Eastfield Community College - Mesquite, TX

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