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Customer Service Medical

Pittsburgh, Pennsylvania, United States
October 19, 2016

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*** ******* ****** **********, ** 15221 520-***-****

Characteristics Profile:

• Handle stress with grace

• Professional demeanor and appearance

• Problem-solver and consensus-builder

• Enthusiastic, confident, friendly presence offering authenticity and a helpful attitude

• Stellar interpersonal skills and commitment to ensure all stakeholders achieve success

• Proven ability to focus, prioritize and multitask in a fast-paced environment

Summary of Qualifications:

Offering 10+ years acute care hospital experience, including but not limited to:

Medical transcription expertise, specializing in acute care report generation for most subspecialties, including radiology/nuclear medicine, oncology and pathology.

ICD and CPT coding experience, EMR [electronic medical record], review of claims data, risk assessment affecting authorizations, denials and appeals.

Legal expertise in the drafting of psychosocial characterization reports for workers compensation claims and/or disability determination, including psychiatric assessments and testing.

Recent and relevant customer care and service experience in a variety of environments including call center.


06/2015 – 02/2016

Gentech - Provider Services Representative

Corporate: 3919 William Penn Highway, Suite 200, Murrysville, PA 15668

On-site: Four Gateway, Pittsburgh, PA 15221 412-***-****

Answered inbound calls to Gateway Health Plan from providers regarding eligibility, benefits and claim status in a call center setting, satisfactorily resolving issues and complaints within strict response time standards. Clearly and concisely explained and reviewed state Medicaid and co-insurance guidelines, and any other policy-related information, to providers while documenting call details accurately in call tracking system. Maintained specific quality and quantity standards (> 98% on average). SOFTWARE UTILIZED: PowerQue, Avaya, MS Outlook and Excel.

09/2014 – 01/2015

Union Orthotics and Prosthetics Co. - Patient Care Coordinator

3424 Liberty Avenue, Pittsburgh, PA 15201 412-***-****

Front desk triage agent and liaison for 10 local offices (approximately 40 practitioners). Verified insurance coverage, accepted and collected co-payments/deductibles. Other check-in and check-out duties including new patient registration, established patient EMR updates, scheduling and rescheduling appointments for consultations, evaluations and treatment. SOFTWARE UTILIZED: OPIE (proprietary) and Navinet.

08/2013 – 06/2014

Radiology Ltd. - Guest Services Representative

677 North Wilmot Road, Tucson, AZ 85711 520-***-****

Front desk check-in position; registered on average 60 patients per day, at the headquarters of Tucson's largest radiology group. Interviewed patients to obtain medical histories, verified insurance coverage, accepted payments, authorized add-ons to daily schedules for MRI, CT/DEXA scans, ultrasounds, mammograms, and x-rays. Stationed at triage desk every other week to manage traffic flow and emergencies. Resolved complaints, service issues, dispatched incoming calls, managed inter-departmental communications, conducted occasional site visits. SOFTWARE UTILIZED: NextGen and Spark.

09/2011 – 02/2013

Urological Associates of Southern Arizona - PBX Operator

6325 E Tanque Verde Road, Tucson, AZ 85715 520-***-****

Responsible for handling approximately 75 incoming calls per 8-hour shift. Provided patient/customer service and problem resolution in support of 12 urologists in 3 offices. Duties included setting and rescheduling appointments, administrative tasks and mailings. SOFTWARE UTILIZED: PBX and proprietary scheduling program.

05/2010 - 07/2011

Weekend Missions - Events Coordinator

500 N 56 Street, Suite 16, Chandler, AZ 85226 520-***-****

Performed missionary work in Mexico.

02/2008 - 04/2010

Northwest Medical Center - Medical Transcriptionist

6200 North La Cholla Boulevard, Tucson, AZ 85704 520-***-****

Provided acute care medical transcription services for 300+ bed hospital in support of 640 doctors on staff; centers of excellence included ED, accredited heart and stroke care, spine and joint programs, and Tucson's only dedicated Women's Center. SOFTWARE UTILIZED: PowerScribe.

10/2006 - 01/2008

AFNI, Inc. (via AppleOne), Tucson, AZ

Customer Care Associate assigned to Verizon Wireless account.

Temporary work assignment in call center.

CitiGroup (via Randstad), Tucson, AZ

Customer Service Representative assigned to Anti-Fraud Unit.

Temporary work assignment in call center.

06/2004 - 08/2006

Shriners Hospital for Children - Medical Transcriptionist

3160 Geneva Street, Los Angeles, CA 90020 888-***-****

Provided general medical transcription support to renowned pediatric hospital, specializing in congenital orthopedics, burn care, cleft lip and palate revision, and spinal cord injuries and neurological disease management.


Associate Degree, Business Administration and Management

Hillsborough Community College, Tampa, FL

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