Customer Service Insurance

DENISE JOHNSON

*** ********* ***** ************, ** 21793 acvkw9@r.postjobfree.com 240-***-****

ADMINISTRATIVE PROFESSIONAL

SUMMARY OF QUALIFICATIONS

Skilled Administrative Professional with over sixteen years of various experience with advanced degree in administration

Ran successful owner operated child care business for two years

Self-motivated, detail-oriented, analytical, easy to adapt professional who consistently surpasses expectation requirements set by the company

Adept and experienced in problem solving and providing solutions to various issues, pre-existing and/or new procedures and methods utilizing previous experience, common knowledge, research, colleagues of similar expertise, and other

Flexible team player prepared to work independently, lead, collaborate, cooperate and willing to help other colleagues to accomplish tasks at hand

Excellent qualifications in interpersonal communications, representing the company, training, guidance, and motivation

Consistently maximize resources to increase productivity, meet deadlines and goals, and achieve customer satisfaction

Trustworthy to maintain security and confidentiality to all information and documentation presented of the organization

Proficient knowledge in: MS Outlook, Excel, and Word; IDX, Sunrise EMR, ICD-9 and ICD-10 coding, HCPCS, CPT and more

Willing to travel if desired

PROFESSIONAL EXPERIENCE

SCHEDULER DECEMBER 2015 - PRESENT

LHC Group – HomeCall of Frederick Frederick, MD

The preferred post-acute care partner for hospitals, physicians and families nationwide

Receive referrals from Central Intake and assign patient care visits utilizing the operating system, in coordination with Team Leader, and consistent with the qualifications of professional and paraprofessional staff

Advises the Branch Manager of staffing needs and performance issues related to the availability of agency staff as needed.

Assists in coordination of scheduling and tracking the 14 and 60-day supervisory visits that are required to be completed per regulatory requirements.

Attends and participates in annual in-service training programs.

Attends and participates in workshops, continuing educational programs, seminars, etc. to keep abreast of current departmental changes.

Participates in on-call rotation for weekend, evening and holiday scheduling as required.

Receives requests for service and maintains a weekly calendar of services scheduled and delivered.

Reviews weekly edit lists for accuracy to assure timely processing of payroll and billing.

Trains/orients new schedulers to the scheduling positions throughout Company.

Uses an automated schedule system to prepare and maintain a weekly calendar of services scheduled and delivered

All other duties as assigned.

INSURANCE COORDINATOR February 2011 – December 2015

BEHAVIORAL HEALTH PARTNERS Frederick, MD

Company provides comprehensive mental health services

Demonstrate overall knowledge of behavioral health benefits for Medicare, Medical Assistance and commercial insurance companies as required

Identify, prioritize and coordinate insurance requirements, needs for pre-authorizations and other “gatekeeper”

requirements and communicate required data to the appropriate provider(s) and billing representative (as appropriate)

Verify patients primary, secondary and tertiary insurance coverage for out-patient services

Exhibit strong knowledge and proficiency in using IDX applications

Track, maintain and verify the number of benefit visits available to patients, complete and accurate documentation, proper FSC order in accounts, billing information, etc.

Respond to all inquiries from consumers and professionals in a timely manner

Follow-up with third party payers to verify coverage, limitations, deductibles and co-payments

RECEPTIONIST March 2010 – February 2011

BEHAVIORAL HEALTH PARTNERS Frederick, MD

Company provides comprehensive mental health services

Answers telephone and either responds to inquiry or directs caller to appropriate personnel

Schedules appointments and enters appointment date and time into computerized scheduler

Conducts reminder calls to all patients

Greets and directs patients

Registers patients by verifying that patient's record is up to date and accurate

Makes appropriate changes in computer system and on patient's chart

Verifies insurance coverage for planned treatment

Solicits referrals from patients

Collects payment from patients and reconciles daily cash report

VOLUNTEER (CLERICAL) February 2008 – March 2010

FREDERICK MEMORIAL HEALTHCARE SYSTEM Frederick, MD

A full service hospital

Typed up medical documents using Microsoft Word, processed paperwork for patients being discharged

Filed and copied co-workers WOW (accolade) cards

Assembled mother –to-be and Labor and Delivery packets together

Assisted patients and visitors to the hospital

SUBSTITUTE TEACHER AIDE/ OFFICE AIDE January 2005 – October 2006

FREDERICK COUNTY HEAD START Frederick, MD

Company provides comprehensive education, social, health, and nutrition services to eligible children and their families.

Performed various clerical tasks: filing, phone calls, typing, photocopying, etc.

Maintained case records and child/family files

Provided supervision and set up activities for children during classroom sessions and while on the bus

CHILD CARE PROVIDER August 2003 – December 2005

JOHNSON’S CHILD CARE Frederick, MD

A safe, stimulating environment for young children. Self-employed.

Maintained program participant records; kept health records, fire drills, receipts, and payments updated as required

Complied with applicable local, state and federal licensing requirements, certifications, and/or regulations

Supervised, organized, and implemented all daily living and age appropriate activities for children in a safe

environment to include: conducting individual and group activities to encourage learning and develop social

interaction skills; preparing and serving meals

POST CLOSING OPERATIONS PROCESSOR II July 2000 – August 2003

WELLS FARGO HOME MORTGAGE, INC. Frederick, MD

A diversified financial services company providing worldwide banking, insurance, investments, mortgage and consumer finance.

Duties included: receiving and reviewing incoming work, contacting appropriate resources as needed, entering

transactions into CRT/PC, balancing general ledger accounts, resolving complex customer issues using multiple

resources and records; preparing, editing, distributing, and/or correcting specialized and/or complex documents

Processed with a high degree of accuracy and attention to detail maintaining above average quality ratings,

department hourly and daily productivity standards

Reconciliation of closing checks to closing documents utilizing ARROW, LPS, and ELFS

MICROGRAPHIC CLERK September 1993 – July 1997

CLAIMS ADMINISTRATION CORPORATION Rockville, MD

An insurance agent/broker company.

Performed clerical duties; filing, data entry, and trained new employees

Batched work accurately for medical, dental, and customer service claims

Collected, organized, logged on, and tallied batches to be registered

Viewed claims on digital workstation to send to various departments upon request

Trained in various departments when available to deplete backlogs

EDUCATION AND TRAINING

ACADEMIC STUDIES

ASSOCIATE OF APPLIED SCIENCE – ADMINSTRATIVE PROFESSIONAL October 2006 – July 2008

KAPLAN COLLEGE Hagerstown, MD

Overall GPA, 3.38

Dean’s List

President’s List

Perfect Attendance

Pertinent coursework includes: Principles of Accounting I Intro-to-Information Technology

Word Processing Principles of Business Management

Intro-to-Spreadsheet Analysis Office Management

Introduction to Internet Business Law

Machine Transcription Presentation Software

Keyboarding Intro-to-Economics

PROFESSIONAL DEVELOPMENT

Certificates, Introduction to Computers and Windows, Intermediate Word, and Introduction to Excel

Frederick Community College, Frederick, MD - 2006

Various Certificates, Child Card Choices, Frederick, MD - 2005

Licensing Certificate, Department of Human Resources – Child Care Administration, Frederick, MD - 2003 - 2005

Certificate, World of Post Closing, and Dream of Home Ownership

Wells Fargo Home Mortgage, Inc., Frederick, MD - 2002

Certificate, Office Assistance, Abbie Business Institute, Frederick, MD - 1991

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