Customer Service Representative
Resume:
PASSIE A. HARLEY
Everett, MA *****
*********@*****.***
QUALIFICATIONS
7+ years experience in Customer Service for leading retail and healthcare
Direct working knowledge of product, merchandise, & safe serve training
Background in cashier, stock, visual merchandising, line server, prep, runner, & waitress
Fashion to Figure, Saugus, MA (seasonal) September 2015- March 2016
Greet customers
Assist in customer’s purchase decision & locate merchandise
Maintain knowledge of sales, store policy, & promotions
Vigilant & recognize security risk & theft
Inventory/stock
Daily & weekly quota
Open & close cash register, process cash & credit payments
Parallon, Claims Specialist Wakefield, MA June 2014-Present
Process WC, MVA, Commercial, & Government bills
Research & verified claim information, EOBs, prior authorization
Communicate with adjusters, attorney’s, & patients for resolution
Appeals, Liens, Rebill, Fax, Email correspondence
Bill for copay, coinsurance, deductible balance on a TPL level
Incoming & outgoing telecommunications
100% accuracy in revenue collection
Maximus (TCS) Member Service Representative Boston, MA. January 2014-June 2014
Inbound calls assisting members in obtaining medical insurance information
Verifying eligibility thru various software, Ma21, Mass Serve, Virtual Gateway, & Mass.Gov
Update & changed member’s address & phone numbers
Completed & mail out forms as needed for members
Escalated / transfer calls to appropriate departments
Educated members on applications, eligibility, enrollment, P SI & ARD
Network Health, (TCS) Member Service Representative Medford, MA Jan 2013-Dec 2013
Inbound calls assisting members & providers in obtaining medical insurance information
Verifying eligibility thru Mass.Gov & Monument Xpress systems
Update & changed member’s primary care doctor, member’s address & phone numbers
Looked up & provided contracting doctors thru Network Health website
Completed & mail out forms as needed for members
Transferred members to appropriate departments
Boston Ballet, Call Center Representative Boston, MA May 2012-January 2013
Inbound & Outbound calls Fundraiser/Sales for the prestigious ballet Organization
Renewed Patrons Subscriptions & generated new revenue
Benefits knowledge & Met weekly quota
Special projects as assigned
Gryphone Telecommunications Braintree, MA March 2010- May 2012
Customer Service (sold) Verizon products
Sales, marketing and product knowledge
problem solvers and strong interpersonal skills
software on a multimedia system
HEALTHCARE EXPERIENCE
Tufts Health Plan Claims Analyst Waltham, Ma February 2008-December 2009
Reviewed physician claims based on information for correctness and completeness according to the fee schedule and allowed amount, review EOB, utilized IDX platform software
BMC HealthNet Plan Claims Adjudicator Boston, Ma January 2007-January 2008
Evaluated Physician claims according to the guidelines
to approve or deny a claim based on the evidence presented
Missing cpt codes, modifiers, units, or provider information, review EOBs, utilized IDX
NEMC and Partners (Winter Wyman) 3rd Party Medical Boston, Ma April 2005- January 2007
Physicians Billing for medical procedures and office visits of services provided by physicians in a HMO setting, utilized IDX platform software
Faulkner Hospital (Kforce) Pre-Authorization Specialist Boston, Ma March 2004-March 2005
Consulted approval for medical necessities procedures prior to date of service for hospitals and specialist providers, utilized MEd iSOFT platform software
EDUCATION & LEARNING
Certification In AAPCICD-10 2015
AHIHA Online course studies specialize in Certified Coding-CCS
Certification in Direct Support Professional Services 2007
Massachusetts Providers' eAcademy
Associate Degree in Applied Science / Visual Communications and Multimedia 2002
Gibbs College, Boston, MA
Computer Technology / IT Networking Coursework 1993
Computer Learning Center, Somerville, MA
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