Customer Service Representative
Resume:
Cicely Balls
Cell: 832-***-****
Email: *********@*****.***
Houston, Texas 77014
To obtain a challenging position in a Professional atmosphere where my ability to interact with a broad base environment which will promote an opportunity for professional and personal development.
Summary of qualifications
. Following software skills-Epic, Touch point, Macess, Navitus, Microsoft version 8.0, Microsoft Outlook, Microsoft Excel, Microsoft Word, IDX version 9.0, HBOC, Medical Manager, Cubs, Facs version 17.0, GUI, Workbooks, Larson,
. Strong interpersonal skills with positive attitude, highly organized and flexible with the ability to effectively handle multiple-task.
. Detailed and deadline oriented, self- motivated and take responsibility and ownership of projects, demonstrated initiatives, able to work as part of a team with leadership skills and capable of working with minimal supervision.
. Skills- Invoicing, General ledger, Payroll- processing, Medicare A&B, PFFS, Medicaid, 50-wpm, 10-key by touch.
. Completion of Nursing Assistant Program.
. Medical Terminology.
. Insurance Terminology.
. Knowledge of Manage care Industry
Experience:
2013-2015 Texas Children's Hospital Houston, TX.
Ambulatory Service Representative II
. Inpatient/Outpatient Admissions
. Inpatient/Outpatient Registration
. Insurance verification
. Schedule PT, OT, and Speech therapy evaluations and series.
. Secures the financial integrity of patient accounts.
Verifies and update current patient demographic (address, visit guarantor, phone, emergency contact number, etc.) and insurance information.
. Provides excellent customer service as the first contact for patients, providers and staff accessing ambulatory clinics.
. Expedites the outpatient check-in and check-out processes by reviewing appointment status using electronic appointment system to view information regarding appointment, insurance, and history.
. Collect pre-visit payments and communicate with the clinic liaison regarding factors impacting the patient visit and general clinic-patient flow.
Secures financial integrity of the patients account by verifying benefits and obtaining referrals, authorizations and pre-certifications.
2011-2013 Texas Children’s Hospital Houston, TX.
Member Service Representative/Back-up Pharmacy Representative
. Provide verification of insurance eligibility, and benefits to patients and physicians and facilities.
. Provide benefits for in-patient and out-patient procedures.
. Advise if particular procedures require authorizations.
. Resolving issues for patients to receive prescriptions refills/new prescriptions.
. Forward complaints to complaints department for resolutions.
. Compliant with HIPPA guidelines and regulations.
. Obtain and verify current patient demographic (address, visit guarantor, phone, emergency contact number, etc.) and insurance information.
. Refer patients to the state for state related issues/resolutions.
2009-2011 United Healthcare Houston, TX.
Customer Service Representative
. Responsible for answering incoming calls from members, and providers.
. Resolving member inquiries that involve benefit and eligibility information.
. Billing and payment issues.
. Member and provider material request.
. Physician assignments, also authorizations’ for treatment.
. Explanation of Benefits.
. Loading new member enrollments.
2008-2009 FMA Alliance Houston, TX.
Patient Account Specialist II
. File (primary and secondary) insurance claims.
. Insurance verification, accurate of insurance appeals, and denials.
. Posted and adjusted payments along with sending patients invoices and balance letters.
. Average calls per day including inbound and outbound.
. Able to meet monthly quota required by company guidelines.
. Assist patients with request for finalized statements and pay arrangements.
2007-2008 Patient Account Services Houston, TX.
Customer Service Specialist/QA
. Average calls per day 75-80. Appointed Co-Developer in QA
. Ensure that new representatives were trained just as well on the production floor as they were in the classroom setting.
. Train on phone etiquette and techniques to prepare res for customer satisfaction where quality comes first.
. The ability to read, understands, and relay information from EOB to patients.
. Post payments as well as adjust per EOB.
. Made sure company voice mail was checked and cleared daily.
. The ability to operate six different systems such as; Noble, CUBS, SMS, IDX, Docstar, and Navinet.
. Capable to endure heavy workloads in a timely manner.
2006-2007 Coventry Healthcare Houston, TX.
Patient Account Specialist
. Heavy phone calls from patients, field personal and providers.
. Provide status of payments to providers and patients.
. Respond to inquiries and special request from management.
. Deal with numerous account codes for correct payment.
. Heavy problem solving on mysterious check payments.
. Assist with new enrollments and provider relations.
. Provide accurate and quality customer service.
2005-2006 FMA Alliance Houston, TX.
Patient Account Specialist II
. Communicate with proper payer to negotiate specific arrangements.
. Insurance follow-up and collections.
. Submitting additional information to insurance carrier's for timely reimbursement.
Education 2013-Current
Texas Southern University
. BS of Health Care Administration to be awarded 2016
. Received scholarship from Texas Southern University
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