Quality Assurance Customer Service
Resume:
Lois A. Hardy
Lady Lake, FL 32159-2162
Phone: 352-***-****
Alt Phone: 352-***-****
********@****.***
Objective
A position that is interesting, has advancement possibilities, new things to learn and a friendly working atmosphere.
Ability Summary
Used eCW EMR system to send medical referrals to specialists, prepared and sent prior authorizations for medications and imaging
Filled in at front desk, answering phones, scheduling appointments
Analysis of medical claims paid by other insurance companies as secondary, comparing the UHC primary rate to the rates on the Explanation of Benefits from the primary carrier in a Microsoft Access database
Quality Assurance of claims specialists work on entering the information from the medical claims and EOB’s
Entering information from medical claims and EOB’s into database
Research in Knowledge Library, NDM and outside websites to update reference materials
Interpreting facility contracts with insurance companies in NDB and SPI’s
Quality Assurance of medical claims processed by claims specialists
Processing of medical claims, including facility, physician, lab and x-ray claims
Customer service for benefits and processed medical claims
Ongoing training for evening crew
Delivered mail and picked up from mail boxes
Receptionist, typed Financial Statements for small business
Inventory control, purchasing
Accounts Receivables
Employment History
09/2012 - 01/2017 Rivers Family Medicine 1503 Buenos Aires Blvd, The Villages, FL
Preparing referrals to specialists to be sent out, which includes checking that the specialist the provider chose is in the patients insurance network, making sure insurance cards, imaging reports, lab reports and any other pertinent information is sent with the referral. Prior authorizations the insurance requires for medications that the providers prescribed, including filling out the forms, calling the patients, pharmacies and insurance companies to get the information needed to get PA’s approved. Prior authorizations the insurance requires for imaging such as CT, MRI and PET scans, etc. I also helped at the front desk checking patients in as well as taking calls that came in, taking care of anything I knew and had ability to do as well as transferring calls to the correct department, and taking messages and sending them to the correct department.
Claims Analyst
09/2002 - 08/2007 UnitedHealth Group (Ingenix} Rocky Hill, CT
Gathered, recorded, did Quality Assurance checks and analyzed data from primary carrier explanations of benefits, comparing the primary carriers contracted rates to what UnitedHealthcare would pay as the primary carrier.
Claims Specialist
11/1991 - 09/2002 UnitedHealthcare (UHC) Hamden, CT
Processed facility bills, did Quality Assurance on other processors work, answered customer service phones. Provided training for night shift employees. When our office was set to close I floor walked for people that wanted their processing skills updated so that they could possibly work at home. I worked at home from November 2001 to September 2002.
Postal Carrier
09/1998 - 12/1998 USPS Shelton, CT
Delivered mail on many routes as a PTF (part-time flexible employee), I worked at least 35 hours a week. Quality Assurance permanent position became available at UHC so I went back.
Receptionist
12/1989 - 10/1991 Harold E Ginter Accountant North Haven, CT
Worked as a receptionist, typed Financial Statements, copied and bound them. Owner decided to retire and gave me time to look for another job before closing.
Inventory Clerk
07/1977 - 12/1989 Hawley Industrial Supplies Bridgeport, CT
The first year I was an inventory clerk, keeping manual inventory cards up to date. For the next 5 years I did Accounts Receivables, posting payments, a manual process that went out to a computer service to create a book of purchases made. Then a computer system was implemented thru a company in White Plains, NY. I went with my supervisor to learn the system. I then went to work in the New Haven office and worked as the inventory clerk, purchasing, handled the cash box, a computer system was then implemented for inventory and purchasing with a few companies as well as a few customers ordering thru the system. When I left I trained an inside salesperson on how to use the system.
Education and Training
Completion Date Issuing Institution Location Qualification Course of Study
06/1976 Bunnell High School CT High School Diploma Business
1983 H&R Block Tax School CT Receptionist Tax preparer
1987 CT Architectural drafting
Occupational Licenses & Certification
Certification Title
12/1995 PTCB CT CPhT Pharmacy Technician
References
Available upon request
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