Customer Service Insurance
Resume:
TERESA KNOX
Richmond TX, 77407
Objective: Motivated individual looking for an opportunity to excel in customer & client contact. Prefer a challenging position that offers opportunity for advancement.
Core Strengths: * Ability to communicate verbally and effectively
Effective and Decisive problem solver
Develops excellent relations with co-workers, management and customers.
Energetic, hardworking and loyal
Excellent organizational skills
Experience: * Negotiating claims settlements
Interacting/negotiating with attorneys, claims adjuster regarding accidents/injuries
Analyzing claims data and provider billing activity
Meeting established metrics
Detail experience in coding methodologies ( ICD-9, CPT, DRG HCPCS and Revenue codes
Working Knowledge of Medicaid, Medicare LTAC, HMO, PPO etc.
Commercial Collections
Medical Terminology Knowledge
First & Third Party Recovery
Claims /WC Adjuster License # 1737581
AAPC Coding Physician Certification Class
Professional Experience:
Memorial Hermann Hosp (Sugarland)
281-***-**** May 2015- Current
Patient Access Rep II
patient Demographic information into system. Collecting ER co pays.
First ability to have very good customer service skills dealing with the patient, peers and physicians
Understand the need of the patient and recognize there condition when they come into the emergency room. Putting
Able to com the family down and patient if it’s and life or death situation.
Be VERY sympathetic to patient needs and able to recognize a stat situation. Putting patient Demographic information into system. Collecting ER co pays. And call any emergency codes that happen in the hospital. ( code blue, code green, rapped response…etc
Professional Experience:
Christus Dubuis Health System Nov 2013 –May, 16 2014 Laid Off
Patient Financial Service Rep: Track the status of reimbursements from Medicare, Medicaid and all commercial insurances. We contact insurers and patients by phone or internet to pursue claims payments for multiple physicians and hospital. Daily follow-up on Hospital claims, appeals and general collections on outstanding accounts. Verify Insurance and post payments. Face to face contact when member come in to talk about their account. Document patient accounts with insurance information. Responsible to adhere to HIPPA & MEDICARE guidelines.
Kelsey Seybold Clinic Oct 2012 –Nov 2013
Financial Reviewer ASR II: Is responsible for the Guarantor Account researches that are assigned by Supervisor, resolves guarantor accounts and billing issues by contacting the patients, insurance carriers regarding outstanding balances. Providing assistance to patients in a frien/ dly and courteous manner. Responsible for check in and checkout functions, including registration and cashiering.
Linebarger Googin Blair & Sampson LLP 2009 – SEPT 2012
Federal Gov. Collector: The collector is responsible for using method of recovery to collect and /or negotiate settlements on behalf of the US Treasury.
Debts include SBA, DFAS, Commercial Collections Veterans affairs compensation and pension overpayments, Medicare overpayments, Medicare secondary reimbursements, Workers Compensation over payments,
Consumer debts etc….Skip tracing accounts for correct information. Using several Federal Government systems to locate telephone numbers and employer information.
United HealthCare (AmeriChoice) Houston Texas Sept 2008-May 2009
Supervisor Operation: The Supervisor is to enable team members to deliver consistent quality service to the provider and members. Continuously coach the team to ensure that individual and team performance goals and achieved. Work closely with Director and Health Plans. Direct the staff and ensuring the staff successfully meets metric goals. Investigate trends, surface issues and identify the root problems. Provide one on one monthly meeting with employee and reports to the Operations Manger. Do yearly reviews, hold staff meetings, do time sheets etc… Maintain high morale by inspiring representatives through reward and recognitions programs.
United HealthCare (Evercare) Houston Texas 2007-Sept 2008
Sr. Claims Analyst: The Claim Analyst is responsible for investigation of claims denials brought to the attention of the Senior Network Account Managers and/or Site Management. The incumbent monitors and alerts upper management of any adverse trends when identified, via review of reports or communication cascaded from the corporate office. The incumbent acts as the department liaison when communication with the corporate office regarding claim resolution and Worker Compensation Claims. The claim analyst accompanies the provider rep. with provider education visits on an as needed basis and work with the Quality Improvement department to research and resolver claim issues brought through the State to Evercare attention.
United HealthCare ( Americhoice ) Houston Texas Sept 2005 – Jan. 2007
Prior Notification Rep: Responsible for intake verification, documentation and communication for information pertaining to precertification of inpatient and outpatient medical services. Responsible for inputting data information of demographic and clinical information into the authorization system known as Care Planner, Identify third-party liability, COB issues Worker Compensation and document in the claims sections of the clinical information system. Monitor plan specific and fax server queue and complete authorization process.
The Rawlings Company Louisville KY Oct 1999 – Dec 2004
Subrogation Analyst: Responsible for maintaining a caseload of approximately 650 files. Primary goal was monetary recovery to collect and/or negotiate settlements for health insurance clients, 1st party Med-pay and 3rd party liability recoveries. Also researching and investigation potential subrogation files via telephone inquiries, questionnaires and reviewing member claim histories, notifying all parties of our clients’ legal rights via verbal and written communication and negotiating lien settlements with attorneys and other responsible parties.
Education: Custer High School – Milwaukee Wis.
Graduated 1982
Milwaukee Area Technical College
Classes and Seminars in Insurance & Supervising
Claims /WC Adjuster License # 1737581
AAPC CPC Class Certificate of Completion
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