Cicely Balls

Cell: 832-***-****

Email: acq9l2@r.postjobfree.com

***** **** ****. # ****

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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