Customer Service Manager
Resume:
Professional Summary
Familiar with commercial and private insurance carriers.
Expertise includes verifying insurance coverage and records reviews Customer service-oriented
Skill Highlights
Maintains strict confidentiality
Knowledge of HMO, PPO Medicare and Medi-Cal
Strong work ethic
Good written communication
HIPAA compliance
Team player with positive attitude
Deadline-driven
Exercises good judgment
Professional Experience
Patient Account Representative II
December 9, 2013 – December 31, 2015
Turning Point Revenue Cycle Solutions
Responsible for all aspects of follow up and collections, including contacting patie nts, insurance carriers, accessing payer websites and follow up on unprocessed t hird-party claims
Reviews, researches, resolves insurance overpayments, underpayments, denials,
Responsible for handling late charge report on a daily basis to reconcile payment s through adjustments/re-billing of primary, secondary and third party claims
Utilizes A/R reports and EOBs to identify and reconcile all outstanding balances t o a zero balance
Act as back up for customer service to handle the overflow of calls as warrants
Responsible for Medicare crossover claim billing
Willing accepts and perform other duties as assigned by Manager/Supervisor Patient Account Representative II/Medicare
February 2006 to November 2012
Sutter East Bay Region Medical Ctr. Oakland, CA
Responsible for full collections of accounts assigned within the Medicare Accounts Receivable (included but not limited to initial collections and denials)
Responsible for reviewing, researching and completions of all denied accounts.
Thoroughly investigated past due invoices and minimized number of unpaid accounts.
Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate information.
Carefully reviewed medical records for accuracy and completion as required by insurance companies.
Strictly followed all federal and state guidelines for release of information.
Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
Confirmed patient information, collected co-pays and verified insurance.
Completed appeals, filed and submitted claims.
Posted charges, payments and adjustments.
Submitted refund requests for claims paid in error.
Responsible for running daily production reports
Responsible for communication between patients, insurance carriers and all third party carriers
Patient Account Representative II/Non-Government
November 2001 to March 2000
Summit Medical Center – Oakland, Ca
Review and call weekly on accounts greater than $50,000 (7 days from bill date)
Review and call within a 30-day time frame on accounts greater than $5,000(15 days from bill date)
Review and respond to Correspondence/Action Forms
Acquired insurance authorizations for procedures and tests ordered by the attending physician
Apply adjustments to reconcile claims to a zero balance
Responsible for re-billing primary and secondary accounts
Responsible for all other duties assigned by the Supervisor/ Manager Senior Claims Examiner/Claims Service Representative September 1999 to August 2001
North American Medical Management – Oakland, Ca
Processed claims through computerized claim payment system
Claims included Primary Care Physicians (PCP), Specialist, In/Out
Professional/Facility claims, Medicare and COB Claims
EDI claims processing (Electronic Data Interchange)
Responsible/Completed various functions related to error reports of electronic/scanned claims
Adjust, reversed and re-adjudication of claims due to system/Examiner error
Communicated with patients, insurance carriers and other third party providers through phones, and written correspondence
Interpret benefit plan provisions
Researched, reviewed, referred and release claims on hold including EDI claims
(Electronic Data Interchange)
Maintained daily log of phone correspondence and production
Preformed special projects/other duties as assigned by supervisor and claims manager
Education and Training
High School Diploma- McClymonds High School
Associate of Arts – Business
Alameda Junior College – Alameda, Ca
Additional Information
Certificate of Completion in Workforce Confidentiality Certificate of Completion in Compliance Training
Certificate of Completion in Annual Health & Safety Training
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