Customer Service Medical Assistant

Dionne Owens

***-** *** ****** *********** Gardens, NY 11413

347-***-**** / *************@*****.***

Diligent extremely efficient, organized and resourceful individual with excellent communication and problem solving skills with the ability to be a leader and team player

PROFESSIONAL EXPERIENCE

Maximus, Pittston, PA 7/14-Present

Specialist Appeals

Makes informal resolution determinations for appeals based on analysis of information submitted by the appellant, conversations with appellant, information derived from CMS databases. Analyzes appeals’ data independently using federal and/or state laws and/or regulations, along with technical direction, guidance, tools, and SOP’s provided by the client. Confirms the accuracy of appeal data and evaluate in light of proposed resolution. Researches appellant/data/reporting problems and modify the existing system. Performs telephone outreach to the appellants to explain the results of the informal resolution determination and answer any adjudication-related questions. Identifies trending patterns and advises SMEs and Sr. Appeals Specialists of areas in need of improvement accompanied by proposed solutions.

Maximus Manpower, Pittston, PA 3/14-7/14

Consultant Appeals Worker

Handle inbound and outbound calls with processing appeals for a Qualified Healthcare Plan, Medicaid, special enrollments, and catastrophic plans under the Affordable Care Act. Assist appellants with calls to the Marketplace applying for a Qualified Healthcare Plan, Medicaid, special enrollments, and catastrophic plans. Makes, suggest determination for disputes based on analysis of date between appellant and office, Medicaid and eligibility appeals. Prioritize issues if more than one issue is involved. Analyze data using federal law, federal regulations relevant contract law, and other sources defined by the client contract. Submit paper work for appellants to with drawl from resolved appeals. Help to adjudicate appeals for appellants. Handle all complex cases with insurance accounts. Writing summaries for appellants to assist with their appeal request, from the beginning of their appeal for the Federal Hearing Officer to review. Use CMS Pega Case system to access all of the appellants’ information. Have use of multiple screens to access all of the appellants PHI and PII. Facilitate calls between appellant and hearing officer and noting account for reviewing.

SHER Institute for Reproductive Medicine, Asbury, NJ 04/13-06/13

Medical Assistant Externship

Assisted physician with ultrasounds, Fluid ultrasounds, scans as well as injections. Provided assistance in the operating room with egg retrievals and transfers and recovery with vital signs. Performed blood draws, pregnancy testing, semen collections and autoclave sterilization of instruments. Prepped patients for examinations. Informed patients of their cycle calendars, called in and wrote prescriptions per doctor and nurse orders. Filed and charted records, answered phones, faxed and scanned information to patients and office staff.

Bank of America, New York, NY 07/04-06/12

Lead Personal Banking Associate

Assisted banking and financial services customers with account management and other financial service needs. Promoted business for bank by maintaining good customer relations and referring customers to appropriate staff for new services. Interviewed/processed consumer loan/credit line requests, obtained referrals from loan customers & accepted accounts.

Keith Clinic of Chiropractic, Charlotte, NC 07/02-12/04

Medical Assistant/Office Manager

Performed all clinical duties; injections, venipunctures, urine dip tests, vitals, DOT's, SSI physicals. Prepared patients for exams/physicals and performed X-rays, Performed 10 units of therapy on patients. Supervised team of four employee's with scheduling, payroll and personal benefits. Scheduled and confirmed appointments, opened and closed office.

Advance Personnel: Assistant, Charlotte, NC 09/00-07/02

Healthcare Administrator

Managed medical office, the office staff, day-to-day operations, accounts payable, and accounts receivable. Supervised other members of the practice's staff, such as receptionists, medical billers, transcriptionists and medical assistants. Developed and implemented processes and procedures for the operation of the practice.

Cardholder Management Services, Hauppauge, NY 02/97-08/00

Customer Service/ Fraud Dept. Supervisor

Investigated credit card fraud or abuse of cardholder information and assigned fraud claims submitted by credit card members.

Interviewed individuals involved, provided assistance to law enforcement, and participated in court trials as needed. Performed charge backs, related functions, and analyzed accounts and transactions to detect potential fraud situations. Handled 10 to 20 call center representatives. Gave authorizations to increase credit card limits.

Blue Cross and Blue Shield, New York, NY 04/95-12/97

Customer Service/ Claims Adjuster

Examined and evaluated claims for payment of various worker's compensation benefits or other benefits under health, dental, disability, or other insurance programs. Approved and denied claims as appropriate initiate payment actions and made adjustments to funds reserved as needed. Investigated claims for compensation and possible fraud. Reviewed permanent injury, death claims, disputed claims. Obtained recorded statements and other evidence of examination for investigation. Advised medical providers, and claimants about rules, procedures, policies and laws concerning the insurance program. Denied dental treatments, surgery, and medical equipment.

EDUCATION

Lincoln Technical Institute, Allentown, PA - Medical Assistant Diploma 09/12-06/13

95.8 % Attendance/4.0 GPA; Recipient of Executive Director's List for Academic Excellence

CPR, American Heart Association; EKG, Certificate of Completion

Coursework included: Medical Terminology & Anatomy, HIPAA/OSHA knowledge of regulations and procedures, Patient Triage (Blood pressures, Temperatures, Vision exams, etc.), EKG's, Glucose Testing, Mono Testing, Blood typing, Injections, Phlebotomy, Lab Safety and Specimens Collections, Patient Medical Record Maintenance, Filing/Charting, Patient Reception

References upon Request

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