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Customer Service Insurance

Location:
San Antonio, Texas, United States
Posted:
October 24, 2016

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ROBERT M ANDRADE

Work History

Conifer Health Solution - San Antonio Texas 78238

Call center/Collection January 12, 2015- April 04/2016

Work with patients and guarantors to secure payments on outstanding account balances from the Baptist hospitals in San Antonio and Arizona hospitals

Different systems used such as Emdeon, QP quick pay, QVM5 and Ace

Assisted with handled payment arrangements

Glacier Technical Solution, (CAMO) - San Antonio, Texas 78247

Telephone Appointment Clerk July 29, 2013- May 22, 2014

Scheduling appointments for MTF using appropriate guidelines

Update patient demographics in CHCS

Used CHCS to track and schedule referral appointments to the specialty clinics at the MTFs

Negotiate appointment date and time

Used T-con and Ahlta for messaging to provider name, location of base, name of medication, best contact phone number for nurse to call back patient for medications refill

Culture Service Group (CSG) - San Antonio, Texas 78247

Claims Processor/Sales December 12, 2011- July 08, 2013

Processing life insurance claims and selling life insurance

Benefit Recovery Third Party Collection Lackland AFB - San Antonio, Texas 78230

Follow Up Specialist July 17, 2006 - March 08, 2011

Processing claims for Department of Defense medical claims, pharmacy claims

Use websites of insurance carrier to verify patients benefits and eligibility

Resubmit corrected claims to payors, sending electronically

Send appeal letters to insurance carriers

Rebill to insurance carriers

Call or use websites of insurance carriers for claim status

Scan medical records or claims to insurance company

Post payments from EOB's

Follow up on accounts when insurance carrier checks were issued

Composite health care system (CHCS) date of birth, insurance verification

American Administrators Group - San Antonio, Texas 78249

Claims Processor March 15, 2001 - May 01, 2006

Process medical and pharmacy claims, nursing home claims, Medicare claims, vision claims

Caremark - San Antonio, Texas 78228

Medical Processor June 02, 1993 - January 29, 2001

Process Pharmacy, Medical, and Medicare claims, International claims

Call center environment

San Antonio Light Newspaper - San Antonio, Texas78205

Pay By Mail (PBM) April 10, 1983 - January 17, 1993

Posting payments from customers from checks and credit cards

Customer service

Education

Brackenridge HS, San Antonio, Texas

High School Diploma

Additional Skills

A.R.M.S. Accounts Receivables Management System (Military program),

CHCS Composite Health Care

Third party billing

Insurance verification experience,

7500 -8500 Keystrokes

Typing 35wpm

Strong communication and Customer service

Imaging, Rims, PPO, HMO, Government claims, UB’S claims, 1500 claims

Computer Skills

Data Entry Terminal (PDT, Mainframe Terminal, etc)

Email Software (Outlook, Thunderbird, etc)

Internet Browser (Internet Explorer, Firefox, etc)

Peripheral Devices (Scanners, Printers, etc)

Word Processing Software (Word, Word Perfect, etc)

Electronic Health Records

Medical Biller

Taking Credit Card Payments

A/R Batches posting Payments

Credit Card Refunds

Next Gen



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