Customer Service Representative

Kaye Mohammed

**** *. ******* ****., **** #***, Winter Park, FL 32792 407-***-**** *********@*****.***

Skills

Proficiency in Chart audits, Insurance verification

• Evaluates prior authorization/ precertification and letters of medical necessity

• Differentiate between the three levels of HCPCS coding system

Abstract doctor ’s notes/SOAP notes to identify diagnosis, procedural codes, using

•

I CD-9, ICD-10, CPT-4, and HCPCS Level I I

• Using and understanding the global surgical periods as applied by the insurance

i ndustry

• Create letters, maintain various documents, using M icrosoft Word and Create

p resentations using PowerPoint.

Professional Experience:

F ebruary 2014-April 2014 Sunshine Healthcare

M aitland, FL

Program Coordinator [contracted]

• Updated members PHI in Trucare using Cit r ix software

• Worked with Case Managers to upkeep correspondence with the members

• Downloaded and prepared 701B forms for electronic filing of members eligibilities

• Completed customer satisfaction calls

February 2012-September 2013 Ambassador Ancillary

M aitland, FL

Customer Service Representative/Billing Specialist

• Insurance verification over the phone and online; utilized AHT, Momentum and

T I MS software

• Processed, copied and filed medical records for billing of Medicare Part B and private

payees

• Checked claim status

• Daily communication with field representatives to assist in retrieving the proper

i nformation

• Order entry

• Filled monthly orders for DME across the count ry

• Audited medical charts

• Communicated order confirmations with facilities

M arch 2008-Februa ry 2012 Med-Bill I nc.

L ongwood, FL

Medical Collector Specialist

• Completing paper/electronic HCFA (CMS) 1500 claim forms

• Insurance Verifications: for Medicare Part A, H MO and private Payee Using

A llscript Software

• Review payments and EOB forms to ensure t imely processing and payments for each

claim

• Research denied claims, using correct forms, prepared appeals and resubmit denied

claims

• Re-billed claims not paid within 30/45 days, depending on individual practice policy

• Posted charges/charge entries, adjusting to patient accounts using AdvancedMD

• Maintained compliance with H IPAA /awareness of HCFA correct Coding Ini tiative

and its rules

Education

Herzing University Winter Park, FL

Associates in Medical Billing and Insurance Coding

H IPAA Certified

Member of AH I MA

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