Customer Service Manager

linda hiles

859-***-**** **** Davjo Dr. Apt, *

**********@*****.*** Highland Heights, KY 41076

PROFILE

Dependable, confident and detail oriented professional is looking for a full-time position with a company/organization that can utilize my years of experience and expertise in Medical and/or Administrative, Management, Advocacy or Fraud Investigation. Proven ability to excel and multi-task in fast-paced environments. Assume responsibility to deliver exceptional service and care while continually looking for suggestions/ways to process improvements.

HIGHLIGHTS OF QUALIFICATIONS/ SKILLS

- Office Management/Accounting - Medical Terminology/Master Menu Numbers

- Leadership/Training Employees - Patient Admission/Transfer/Discharge

- Maintain: Charts/Records/Files/Timesheets - Dictated Reports/Ensured Adherence to Policies

- Knowledge of: Regulations/Policies/HIPPA - Resource Advisor

- Coordinate: Care/Intakes/Assessments - K-CHIP/Center for Employment and Training

- Medical Care/Billing via Phone/Computer - Cabinet for Families and Children/Hope VI

- Assisted: Orientations/Payroll/Benefits - Welfare-to-Work/DCBS

- Respiratory Therapy/Read Heart Monitors - Communicate:Customers/Patients/Employees/

- Process Applications, Enroll/Register Supervisors/Doctors/Outside Professionals

PROFESSIONAL EXPERIENCE

Claim Follow-up Specialist Medicaid/Medicaid HMO’s, 5/2016 to Present

University of Cincinnati Physicians Billing, Cincinnati, Ohio

The Claim Follow-up Specialist is responsible for account resolution and resolving issues associated with unpaid/improperly filed insurance claims.

Ensures timely, effective and thorough management of physician practice claims to ensure full, expected reimbursement for services provided

Accesses claims from the work queue and queries claim status with the payer, utilizing all appropriate systems to effectively research the claim.

Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management

Researches and/or ensures that questions and requests for information are addressed in a timely and professional manner to ensure resolution of outstanding claims

Completes follow-up with patients to obtain additional information, when necessary

Performs ongoing monitoring and follow-up of claims worked to ensure maximization of collection dollars

Executes the rebilling or reprinting of claims as necessary

Verifies receipt of necessary billing information and confirms if additional information is required from the payer to reduce variances, rejections or denials on patient claims

Completes and/or requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment

Reviews, works and reports all claims that have aged more than the specified grace period stipulated in the policies and/or contracts

Follows up with payers, proactively, to provide necessary additional documentation for claims that have been reviewed by payers and are awaiting documentation to determine adjudication

Documents all follow-up activities in Care PATH

Escalates claim resolution to management when necessary

Serving as a liaison for issues between the CPBC and other departmental units: Customer Service, payment posting, and coding

Performing other relevant work functions, as requested by the Manager/Supervisor

Claim Follow-up Specialist Medicare/ Financial Assistance, 5/2012 to 5/2016

Mercy Health Partners, Cincinnati, Ohio

The Claim Follow-up Specialist is responsible for account resolution and resolving issues associated with unpaid/improperly filed insurance claims.

Ensures timely, effective and thorough management of physician practice claims to ensure full, expected reimbursement for services provided

Accesses claims from the work queue and queries claim status with the payer, utilizing all appropriate systems to effectively research the claim.

Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management

Researches and/or ensures that questions and requests for information are addressed in a timely and professional manner to ensure resolution of outstanding claims

Completes follow-up with patients to obtain additional information, when necessary

Performs ongoing monitoring and follow-up of claims worked to ensure maximization of collection dollars

Executes the rebilling or reprinting of claims as necessary

Verifies receipt of necessary billing information and confirms if additional information is required from the payer to reduce variances, rejections or denials on patient claims

Completes and/or requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment

Reviews, works and reports all claims that have aged more than the specified grace period stipulated in the policies and/or contracts

Follows up with payers, proactively, to provide necessary additional documentation for claims that have been reviewed by payers and are awaiting documentation to determine adjudication

Documents all follow-up activities in Care PATH

Escalates claim resolution to management when necessary

Serving as a liaison for issues between the CPBC and other departmental units: Customer Service, payment posting, and coding

Performing other relevant work functions, as requested by the Manager/Supervisor

Epic

Customer Service Representative, 10/2011 to 5/2012

Mercy Health Partners, Cincinnati, Ohio

Provides supportive assistance to patients regarding billing concerns/issues

Answers incoming calls from patients and returns calls, addressing patient’s questions or concerns in a professional and ethical manner

Interacts with patients, family members, external healthcare related companies, law firms, co-workers and other CHP employees to resolve billing issues or concerns

Assesses the nature of incoming calls and identifies and completes appropriate action in a prompt manner. Activities may include:

oResearch specific transactions on a claim

oRe-send patient statement

oRe-bill a claim

oAdd or change insurance information

oVerify eligibility on account

oPull an explanation of insurance benefits for payment information

oRequest adjustment on a claim

oSend itemized statements

oCounseling, as appropriate

oDirect customer to the appropriate responsible party to resolve concerns outside the CBO, as needed

oPost comment(s) into Care PATH documenting patient’s concern and the actions taken

Internal Support Representative, 11/06 to 8/12

Vangent/Medicare Medicaid Services, Corbin, KY

Handled Medicare claims/billing and priority telephone inquiries while meeting department goals

Up to date knowledge and Adherences of HIPPA and CMS regulations/policies

Review/maintain Empower, daily and report system issues and errors immediately

Complete Deltek timesheet daily before end of employee’s shift

Attentive for possible suggestions/improvements, which would benefit Vangent or customers

Maintain phone inquiries: utilize databases/materials, report problems and assist with resolution

Provide leadership/guidance in all processing activities to BBC Contract Staff

Communicate internally: BBC Regional Manager, Customer Service Managers, Supervisors, etc.

Assist with delivery of internal employee training for new and temporary employees as requested

Perform duties as assigned

Unit Clerk ICU/PCU, 9/05 to 1/06

Manchester Memorial Hospital, Manchester, KY

Correctly abbreviate medical terminology

Telemetry Tech in ICU/PCU

Understand/implement: Patient Safety Protocols/Procedures and Properly Contacting Physicians

Ensured adherence to the Hospital Visitation Policy

Proficient in: Master Menu numbers, Dictated Reports, Respiratory Therapy, Patient Transfers/Discharges/Admissions, Maintenance of Patient Charts, Phone Etiquette, etc.

Human Resource Assistant, 9/03 to 7/05

Laurel Grocery Co., LLC, London, KY

Update employee files, daily and Record: tax data, attendance, evaluations, terminations, etc.

Process employment applications and assist with New Hire Orientation

Assist in answering employee questions dealing with benefits enrollment and coverage

Compile and maintain records for use in employee benefit and salary administration

Schedule other pre-employment and post-accident screening tests

Oversee FMLA Benefits, STD, LTD, complete insurance paperwork and submit to agencies

Assist payroll department

Word 2002, Advanced Excel, PowerPoint

Advocate, Resource Advisor, 8/97 to 1/03

Brighten Center Inc., Newport, KY

Administrative Assistant for Main Office

Accounting

Worked with: Cabinet for Families and Children, Welfare-to-Work, Hope VI, DCBS

Processed K-CHIP, worked with Northern Kentucky Family Health to register children for K-CHIP

Monthly K-CHIP meeting in Frankfurt, submitting feedback as necessary

Overseen funding and the Financial Aid program for the Center for Employment Training

Maintained accurate records for 3 programs and available funding

Met weekly with class instructors to evaluate the progress of each trainee

Outreach strategies, Gave tours of training facility and enrolled perspective clients

Resource advisor, assisted all trainees with possible barriers and did upkeep of trainee files

Other Skills

Trainings: Leadership Tracks, Appalachian Culture, the Council on Accreditation Process,

Assessments, HIV/AIDS Education, Diversity Workshop, Hispanic Culture, Suicide Prevention, Medical Terminology, Caring for the Elderly, State Laws and Facility Inspections,

Computer Skills: Word, Excel and Power Point

Awards: Boiled Frog Award (from Brighton Center) and numerous other awards

Education/Certifications

Certificate of Completion, Southwestern College of Business, Edgewood, KY

Certified: Heart Arrhythmias, Manchester Memorial Hospital, Manchester, KY

Contact this candidate