Customer Service Medical
Resume:
Jean Brayboy
Graham NC, *****
****************@*****.***
Objective: To acquire a position that will allow me to fully utilize my Professional and Medical skills and knowledge.
Experience:
UNC Healthcare
4/2011 to Current
Patient Financial Service Representative
: Processing adjustments to patient accounts and answering correspondence from multiple sources.
: Corresponding with insurance carriers in all aspects via phone, email or fax to obtain prior authorization and benefits for all elective and ER inpatient and outpatient medical/surgical services.
: Corresponding with workers compensation on all cases that are deemed a workers comp case and follow up with obtaining authorization for services from Adjustors.
: Direct contact with North Carolina Department of Correction on all ER, elective inpatient and outpatient cases to obtain authorization.
: Direct contact with Medicaid and Carolina Access to assure that authorization is obtained for CPT codes that they have specified needing authorization.
: Direct contact with NC Track for verification of Medicaid coverage as well as working with NC Tracks for overrides when NPI are not correct
: Reviewing with insurance carriers and well as schedulers and physicians that all ICD9 and CPT codes are correct prior to patient procedures.
: Interrupts clinical to obtain correct ICD9 and CPTS codes and authorization.
: I am the insurance specialist for all Hillsborough GI cases and United Healthcare vascular cases .
: I work directly with the Rehabilitation Case Managers at UNC, insuring the verification process have been completed for a patient admission to Rehab.
Blue Cross and Blue Shield of New Mexico Quality Department
May 2005- Nov 2010
Customer Service Quality Auditor/Coach
: Auditing Customer Service using Nice and EPPS. Entering and recording quality results into the EPPS system
: Responsible for reviewing random samples of all levels of advocates. Auditing each item to determine if the out come was appropriate
: Providing quality results to Supervisors and advocates to enhance performance
: Identifying and communicating training needs to management
: Performed random analysis of call error and make recommendation to management for areas of improvement.
Blue Cross and Blue Shield Provider Service Unit
June 2002- May 2005
Customer Service Advocate III
: Answered incoming calls from Providers/Members/Brokers/ other insurance carriers. Average calls taken per day 35-50
: Experienced in working with all lines of business such as PPO, EPO, HCA, POS, HMO, Medicaid, Medicare and Medicare supplemental plans.
: Provided provider and member education on how their claims processed and paid. Researched appeals sent in by the members and providers.
: Responsible for researching policy, procedure and guidelines regarding group benefits and inquiry processing.
: Assisted with new customer service trainees in navigating the BCBS systems (dashboard, blue star, acrobat and quoting of benefits) before they were assigned to a unit. Assisted in training new advocates on how to provide excellent Concierque Customer Service.
: Assisted others advocates in handling member/provider inquiries by verbally responding to questions regarding benefit/claims.
Blue Cross and Blue Shield Indian Health Service
August 1998- June 2002
Customer Service Advocate I & II
: Answered incoming call from providers regarding status of claims/purchase orders.
: Researched and processed purchase orders for all of the Indian Health facility throughout the United States
: Provided provider education on how to complete purchase orders
New Mexico Urology Group
Oct 1997- August 1998
Scheduler and Coordinator
: Scheduled appointment and surgeries for the attending physician
: Gather Medical history to prepare charts for new patients
: Schedule x-rays/labs/and procedure perform that the hospital.
: Collected copays, coinsurance.
: Verified insurance and obtain authorization
: Assisted Physician with simple procedures
New Mexico Heart Institute
Oct 1993- Oct 1997
Account Service Rep
: Responsible for handling patient accounts
: Responsible for resolving denied claim from insurances carriers for these accounts.
: Setting up collection accounts for patient balances
: Responsible for setting payment arrrangement account that where self pay.
Presbyterian Hospital
1989-1993
Patient Escort
Phlebotomist
Pathology lab
Surgery Scheduler
Education:
Central Carolina Community College
Complete Classes for:
Electronic Health Records Data
Medical Coding ICD 9 and 10
Cpt
References:
Dawn Harris: College Teacher: 919-***-****
Denise Henderson-Supervisor: 336-***-****
Juanita William-Manager: 336-***-****
Interest:
Play softball, camping, dancing, fishing, hanging out with my kids
.
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