Customer Service Medical
Resume:
Robin A. Wiseman
*********.***@*****.***
Objective: I am seeking a position that will continue to challenge my current abilities and to acquire additional skills for a fulfilling career.
Core Qualifications
Administration Experience PMN
Microsoft Access and Excel SharePoint
PowerPoint AS400
IDX Software Customer Service Skills
Customer Service Skills Processed Eligibility & Enrollment Records
Alpha &Numeric Key Nextgen System
Professional Experience
Inmar, Healthcare Network, Winston Salem NC, AR Specialist (2013-Current)
Retrieved remits from SharePoint portal for Kroger.
Prepared remits for transport utilizing AS400 and PMN programs for Kroger and Wal-Mart Teams.
Keyed remits in AS400 system for Wal-Mart Team.
Med3000, Winston Salem NC ~ Payment Specialist (2011-2013)
Posted Patient and Insurance payments to accounts in Nextgen System.
Entered denial codes accordingly.
Verified checks received against summary transmittals.
Balanced payments against computer entry on a daily basis.
Itemized any discrepancies on paperwork and forwarded to CSR’s for follow-up and research.
Wake Forest Baptist Health Business Operations, Payment Specialist (2002-07) (2009-11)
Metrics: Exceeded daily metric transaction goal; Posted bulk checks with high dollar amounts aiding in department to meet month end goals.
Responsible for maintaining a lockbox for Insurance Provider and Patient checks.
Daily balancing of checks that I posted; Completed report with total dollar amounts and batch numbers.
Outpatient Baptist Clinic: posted personal check payments and credit cards from patients.
Assigned to delivered department checks posted and deposits to Wachovia Bank.
Patient Accounts: posted payments using IDX Software for BCBS Anthem, United Healthcare and Medicaid; verified patient’s insurance eligibility.
Upon completion of the payment process, requested coordination of benefits, refunds, reimbursements, when applicable; sent requests to CSR’s for follow-up.
Processed payment denials in accordance with individual PPO rejection codes.
Contacted other healthcare providers with regard to checks and payments requiring research.
ACS Benefit Services, Inc. Winston Salem NC, Fufillment Specialist (2007-2009)
Process Improvement: maintained and set-up easy access file for all Clients enabling status updates promptly; Generated accurate and timely Client metrics.
Served as primary Client contact and liaison between Client and internal Departments.
Performed daily audits and eligibility records to Pharmacy Benefit Managers and Catalyst.
Verified terminations, changes, and enrollments records in comparison to the Daily Error Report.
Renewal Groups: Interpretation of Group Amendments, and applied any changes
(Pre-certification, PPO, Co pays, logos) applicable to Medical, Dental and Rx ID Cards.
Responsible for manual adds of eligible members and demographic information to the Catalyst RX system, when applicable.
Created Training Manual and PowerPoint Instructional and trained employees.
Generated eligibility files from Blue Cross Blue Shield: Audited files and distributed medical and dental ID cards to members.
QualChoice of NC, Winston Salem NC, Cobra Administrator (2000-2002)
Processing of COBRA enrollment forms and generated monthly reports within regulated time frames; handled and setup re-instatements for eligible members.
Attended meetings and seminars to review guidelines and new regulations.
Prepared HIPPA Coverage Certificates as per State and Federal Guidelines.
Set-up COBRA Accounts and posted monthly premiums to existing accounts.
Processed terminations, changes and enrollment packages.
Updated member’s coverage with prescription carriers and providers.
Generated letters and payment coupons to members.
Aon Consulting, Inc. Winston Salem NC, Data Analyst • COBRA Administrator
(1998 – 2001)
Implemented and facilitated account changes and new requirements
Administrated COBRA and Group health plans for various groups; attended weekly meetings and recorded minutes, transcribed onto memos for distribution within the company.
Built and maintained strong relationships with internal and Client counterparts.
Provided weekly and semi-monthly analysis of enrollment eligibility; transmitted medical and dental records, 401K and other employee electives via Hyper Terminal system.
Updated eligibility records following weekly download of payroll files reflecting deductions; research and follow-up when necessary.
Prepared daily auto processing of correspondence, medical cards, and other insurance plan documentation.
Provided employees with individual premium rates and balances in accordance with Group Health Plans.
Maintenance of employee records through Microsoft Access Link, and Excel spreadsheets; generated Group Plan reports, updated eligibility database reflecting changes, renewals, or cancellations to employee files.
Navigated the Client website to assist employees with adds, changes, or renewals during open enrollment.
Additional Training & Achievements
Exceeded department metrics helping to stay on track with department goals
Lean Six Sigma Yellow Belt Certification
Microsoft Excel 1 and 2
PFM Training
HIPPA Certified
Medical Terminology Certification
References Available Upon Request
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