Customer Service Representative

Allenette Smith

**** ******** ** *** **, Citrus Heights CA 95610

**************@*****.*** 916-***-****

Sutter Health CBO 10/2004 - 10/2008

Medical Biller Ancillary/High Dollar

VA Medical Biller/Champus/Tricare Biller

*Proficiently processed claims for nine hospitals

*Highly experienced in commercial health insurance

*Reviewed medical records for accuracy and completion as required by insurance company

*Completed and submitted appeals

*Applied payments, adjustments and denial information in medical managed system

*Researched and submitted refunds paid in error

*Performed QC of the data entry system verify that claims and payments were posted correctly

*Prepared all required claims documentation and correspondence to reduce incidence of denials

*Efficiently performed insurance verification and precertification and preauthorization

*Thoroughly investigated past due invoices and minimized number of unpaid accounts

Jacobson Staffing 08/2003 - 02/2004

Claims Service Representative

*Reprocessed claims in MS4 according to subscribers benefits for payment and denial

*Adjustments to claims based on group benefits and matched authorizations

*Provided customer service for the members and providers

MHN 11/2001 - 7/2002

Claim Examiner

*Verified patient eligibility

*Verified authorizations on record according to patient benefits

*Processed claims accurately and conforming to quality, production standards and specifications

*Matched authorizations according to CPT and ICD coding to determine payment or denial

Blue Shield Of California 03/11/96 07/1997 - 06/2000

Customer Service Representative/Member Service/Telecommuter

*Achieved 98+ calls a day

*Assisted providers of locating procedure codes in the CPT manual

*Quoted health benefits

*Examined claims correspondence

*Completed several special projects for supervisor

*Focused on one call resolution

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