Customer Service Medical
Resume:
Thelma M. Ashley
acw3iw@r.postjobfree.com
Professional Summary
A highly-skilled analytical worker with customer service experience who has excellent formularies knowledge and significant experienced working in any environment. Possesses strong auditing and follow-ups on professional or facilities bills. Have more than twelve years of experience of medical claims and billing reimbursement.
WORK EXPERIENCE
Bank of America August 2016 -Present
Data Entry Clerk
Process checks, coupons, and credit card statements to meet customer’s need in a timely manner.
Workers’ Compensation Reviewer
Established guidelines for proper coding/billing for provider states.
Collaborate with insurance adjusters and medical providers to verify the authenticity of information listed on medical claims.
Aid in the profile set-up of different negotiation of medical payments and pharmacy bills for discounted services.
Post and reconcile insurance payments to patient accounts.
Follow-up on insurance and patient aging claims. Resubmitted claims as necessary.
Knowledgeable in timely filing restrictions.
Utilized national database systems to accurately input required vital information or research prior to finalizing bill payouts.
Checked employees worked as a Quality Assurance Representative.
Assign ICd-9 codes to physician’s diagnosis and insured correct level of service and other various codes.
Ran report daily for different offices in other states.
Property & Casualty Claims Setup Technician
Coordinated claims processing activities including verifying coverage, researching policy information and opening claims electronically.
Communicated with internal teams, outside vendors, insurance adjusters and underwriters throughout verification process
Thelma Ashley
acw3iw@r.postjobfree.com
Assigned severity codes based on loss descriptions and setup acknowledgement letters to maintain compliance with SAI’S.
Maintained a high level of data integrity by ensuring information is accuracy.
Called clients to verify insurance coverage.
Awarded promotion by demonstrating reliable and excellent communication and customer service skills.
JC PENNEY’S
Six years of experience in cashiering and customer service arena.
Demonstrated attention to detail and ability to work in a self-directed manner.
Highly competent at typing and keyboarding.
Greeted customers as they arrived and directed them to merchandise.
Balance all transaction at the end of the shift for cash reconciliation.
DELTA DENTAL INSURANCE
Accuracy entered dental payments for claims processing.
Used EOB to determine patient payments.
Keyed schedule-fees agreement for negotiation rates.
Verified all information was correct for payment from different providers or clients.
INTERAL REVENUE SERVICES
Analyzed different tax forms for errors and processing.
Organized files for collecting data to be entered into computer.
Kept sensitive information confidential.
Reviewed documents for completion and were legible to read.
Posted payments for customers to receive checks.
EDUCATION
B.A. Kaplan University
Business Administration
A.A.S Gwinnett College
Medical Administration
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