Customer Service Insurance

Linda R. Fisher

**** ****** **. ********, ** ****3

513-***-****, ***********@*****.***

Professional Experience

Express Scripts 10/2006 – 06/15/15

Client Services Support Specialist – responsible for ensuring high-quality service delivery to members and clients in a cost-efficient manner.

I address escalated or complex inquiries from clients related to member specific pharmacy benefits, while welcoming members or clients on all types of Customer Service.

Work to research and resolve mail order and claims issues and inquiries within CSC guidelines and document inquires and resolution in a centralized database.

Patient Client Advocate II – Maintain required rating in productivity and audits.

Maintain handle time per requirement of department. Cross trained in OE prep area of Pharmacy. Performed inbound and outbound calls to members assisting with mail service transition, also began Pharmacy Technician Training

WellPoint NextRx Pharmacy 08/2007 – 11/30/2009

WellPoint, Inc. Precision Rx Specialty Solutions 10/2006 – 8/2007

Responsible for insurance verification of all assigned referrals. Obtained Prior Authorization if needed for medication ordered by physician. Initiate referrals within WMDS for medication. Contacting insurance plans concerning benefits and coverage.

Option Care Enterprises/Chartwell Caregivers 03/2005 -10/2006

Reimbursement Specialist- Billing Commercial insurances for Durable Medical Equipment. Focused on research and analyze benefits for collections from insurance company.

Collections Specialist performs account follow-up and resolution of patient receivables. Identify coding or billing problems from EOBs and work to correct the errors in a timely manner

Identify problem accounts and escalate as appropriate

Update the patient account according to company policy

A-1 Healthcare 8/2000 – 8/2005

Helping our customers with Durable Medical Equipment and substantially increase our Respiratory nebulizer program.

Verifying the insurance and advising if the equipment was covered under insurance benefits or assisting with programs to enable monthly copay. Developing and updating daily the Excel spreadsheet of all respiratory patients with oxygen and/or nebulizer treatments. This was a tool for our office to assist therapist and others with needed updates for required prescriptions for therapy’s required by Medicare and Medicaid, most private insurances laws.

I worked closely with the respiratory therapist, for continued education of the benefits of oxygen and nebulizer treatments, when ordered by the physician. Made outbound calls to physician offices to request prescriptions for testing and required updated documents.

Education

University of Phoenix –received Associate Degree in Health and Human Service and working on the completion of my BS degree

Palmer College –Chiropractic Assistant and Billing Procedures 1984 –Iowa

Scott Community College –Nursing 1981-1983

Continuing Education

Learn point – All WellPoint required classes thru 11/2009

Advanced Training – Analyze Your Use of Time

(FACETS)- Enrollment & Billing

(FACETS)- navigation Overview (All): Claims and Service

Handle Calls with Confidence and Professionalism

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