Customer Service Insurance
Resume:
N icole D. Collins
Baltimore, Ma ryland 21215
443-***-**** (email) ***********@*******.***
Skills Summary: Proficiency in several software packages. Excellent telephone and communication skills. Ability
to meet departmental goals in managing patient healthcare needs.
Employment History
J ai Medical Systems, Baltimore, Maryland 21212 09/2013 to present
Customer Service/ Claims Processing
My responsibilities are ; Assisting with Customer Service calls while giving exemplary service to our members.
C laims inquiries, appeals, payment posting and claims processing and follow up. Updating the outreach database
after all outreach efforts have been performed. Refer non-compliant patients to Local Health Department. Attend
weekly meetings with State Ombudsman and Maryland Healthcare Access. Welcome new members to health plan,
confirmed that insurance card and reference material have been received. Represent the company at health fairs,
medical conferences, medical offices, State of Maryland events etc.
F rankford Nursing and Rehab, Baltimore, Maryland 21206 12/2011-09/2013
Business Office Coordinator
Responsible for billing and posting all insurance charges to Managed Care Organization accounts. Collect
payments for private, co-pay and Medicare charges. Determine insurance verification, filing for estate claims, and
f inancial admission screening. Transfer eligible files to third party collections. Attend weekly meetings to
determine residents discharge dates, and determine if residents need to apply for LTC insurance. Requested
award letters and notice of eligibility from the Social Security Administration and the Department of Social
Services. Apply for responsible payee for residents on the behalf of the facility. Complete redetermination packets
and collecting proper documents to apply for LTC MA for the residents. Assist in RFMS and cash handling.
P repare files for litigation and appeals.
Ameritox I nc, Columbia, Maryland 21046 9/2010-12/2011
QA/QC Representative/ Customer Service Supervisor
Implementing SOP for cash application dept., denials department and error processing. Auditing 10% of all work
f rom each department, monitored phone call for quality, updated attendance, time sheets. Counseled employees
daily for job performance and attendance issues. Trained new employees, attended customer service workshops
and initiated further education for employees. Presorting claims, updating spreadsheets, created and monitored
QA reports and analysis clerical duties as assigned. Working special billing projects as assigned. Accounts
receivable follow up and claims reconciliations. Monthly insurance verification to established patients as well as
new patients, obtained precertification from insurances, contacted physician office for referrals.
U niversity of Ma ryland Medical Center, Baltimore, Maryland 21201 12/2008 to 8/2010
Medical Practice Representative
Front desk/clerical duties as assigned Greeting visitors, answering phones and scheduling appointments based on
modalities. Registering radiology/interventional radiology patients prior to seeing a physician, collecting copays,
deductibles. Perform film library duties when needed. IDX and RAD database certification.
Mid Atlantic Healthcare, Owings Mills, Maryland 21117 4/2004-5/2008
Quality Assurance Team Lead
Assisted in confirming all deliveries, making sure that all open orders were accounted for. Verified all insurances
Medicare, Medicaid, commercial insurances etc,, requested pre-cert and referral coordination. Performed data
entry duties utilizing Mestamed billing software. Trained new employees on phones and computer software when
assigned. Claims and A/R follow up with commercial insurance. Corrected and submitted corrected claims,
verified eob’s and remittance.
Ma ryland Physicians Care, Baltimore, Maryland 21244 3/2001-4/2004
Customer Service/Outreach Representative
A nswers and/or appropriately refers customer service questions from members and providers using departmental
resources to ensure customer satisfaction. Assist members, providers and state agencies with member enrollment
and placement into healthcare sites. Telephonic outreach to members with healthcare needs interacting with local
health departments for outreach services. Member analysis, appointed complaint liason for Health Choice provider
network Attended town hall meeting as well as semi- annual meetings with Health Choice providers.
Howard County Government, Ellicott City, Maryland 21043 2000 to 2001
E mergency Medical Dispatcher
D ispatching emergency and non-emergency calls utilizing a 3 way radio. Extensive training life saving procedures,
local and government databases, and medical terminology. Answering calls from ACD que emergency and non
emergency. Entering wanted subjects, stolen items, and missing persons into CJIS and NCIC.
E ducation
Carver Vocational Technical High School Baltimore, Maryland 21205
H igh School Diploma (Industrial Electronics) June 1990
Advanced Career Training Baltimore, Maryland 21201
Information Processing August 1996
References
Available upon request.
Contact this candidate