Customer Service Representative
Resume:
SANDRA (BLACKWELL) BOURSAW
Spring Branch, Texas 78070
Career Objective:
I want to be able to work in an Environment that has strong goals and to use the skills I have worked on for many years. I have a background in research for completing Medicare Audits. Oxygen, Cpap/Bipap Units and General DME in appealing the Medicare Audits with documentation of Medical Necessity to keep claims in a payable status. I understand the ability of a good Customer Service Representative as I was one for over 20 years.
Professional Experience:
LONGHORN HEALTH CARE--Medicare Oxygen Coordinator - May 4, 2015 to Oct 28, 2015 Verify all Medical Orders, Progress notes and documentation for Medicare Oxygen orders. Validate/Log Certificate of Medical Necessity (CMNs) before Billing to Medicare. Coordinate timely responses from Sales Representatives and Medical Offices for return of Medical Documentation. Communicate to Patient and Doctors office regarding the renewal of Oxygen per Medicare guidelines. Scan Medicare Documentation into Document Management. Manage Stop/Hold Report monthly.
CGI FEDERAL--Call Center Specialist - Feb 2014 to April 2015 Medicare Secondary Payer (MSP) Specialist – Call Center I am responsible for providing telephonic support to customers inquiring about an outstanding debt to Medicare including Employers and Group Health Insurance Companies. Provide accurate and timely responses to queries. Escalate queries that are not routine or have special circumstances to supervisors in alignment with prescribed processes.Use analytical/critical thinking skills to determine the nature of phone calls, appeals, and correspondence; follow Standard Operating Procedures (SOPs) to achieve call/case resolution. Researches case information by effectively using internal technical tools in response to inquiries including but not limited to, authorizations, payments, defenses and appeals. TexCare Medical & Oxygen
Accounts Receivable *Jan 2007-Feb 2013
Prepared and handled billing for DME accounts to ensure timely reimbursement Reviewed bills for correct product, correct HCPC codes, physician information and correct payers Submitted and followed up on Certificate of Medical Necessities Research old outstanding accounts
Appealed & Audit accounts
Stepped in and assumed additional responsibilities during periods of personnel changes Daily deposits, Posting Private Insurance & Patient Checks Quality Assurance of Patient Charts to assure payment Daily Reports
AAA MEDICAL & OXYGEN
Lead Customer Service Representative *July 2001-Jan 2007 Intake Process, Delivery confirmation and confirming tickets Daily Route Tickets of Recurring 02 deliveries
Verification all insurances for orders pending
Patient Collections
Documented all DME orders for Sales Representatives Sales Representative for 6 months
APRIA HEALTHCARE
Supervisor Customer Service Representative *June 1996-July 2001 Verified primary and secondary insurance coverage and confirmed payer requirements we’re met.
Verified all DME orders were processed, delivered and confirmed Quality Assurance of all orders before sent to Billing Ordered Nebulizer Medications from Apria’s Drop ship Pharmacy Follow up with Case Managers on Processed orders
Other Experience:
CAS/HIGLAS/DCS/CWF
Brightree Internet based DME/HME Software
Microsoft Word
Excel
Certificate of Completion to Medicare Workshops
Knowledge of All DME equipment. *Have delivered most equipment to patients in their home or hospital
Education:
Harlandale High School Graduate
St. Phillips College
Cross Country Education for Medicare Billing
National Provider Compliance Corporation for Medicare Changes Various training In Quality Assurance, Privacy Act
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