Customer Service Insurance Claims
Resume:
Lena Diaw
Katy, TX *****
*********@*******.***
Customer service oriented professional who provides timely and accurate data to ensure reimbursement for patient services. Follows policies, procedures and guidelines to assure consistent quality. Maintains and ensures patient privacy and confidentiality.
• Academic Honors Recognition / Honor Roll.
• Fully capable of organizing large number of records and documents.
• Experience using MAC, Microsoft Word and Excel.
• Experience using EMR and EPIC systems
Authorized to work in the US for any employer
Work Experience
Medical Claims Analyst
United healthgroup - Denver, CO
February 2022 to December 2022
• process medical insurance claims.
• verify the authenticity and eligibility of claims,
• analyze the billing, communicating with policyholders,
• Calculating and tracking various company financial statements through EMR system
• and ensure adherence to all the policies and regulations during the entire procedure. Claims Examiner
Manhattan Life Insurance Company - Houston, TX
July 2021 to January 2022
• Review insurance claims to verify that due process was followed in the investigation
• Reporting of claims by both claims adjusters and claimants.
• Collaborating with patients, third party institutions and other team members to resolve billing inconsistencies and errors
• Ensure legal compliance, approve or deny insurance claims and provide assistance to claims adjusters when needed.
• Submitting Authorization to Insurance in order to admit patients. Claims Processor I
NEW ERA LIFE INSURANCE - Houston, TX
October 2018 to July 2021
• Communicating with insurance agents and beneficiaries.
• Preparing claim forms and related documentation.
• Reviewing claim submissions and verifying the information using EMR system
• Submitting Authorization to Insurance in order to verify eligibility of the clients.
• Recording and maintaining insurance policy and claims information in a database system.
• Creating invoices and billing materials to be sent directly to a customer or patient
• Processing claim payments.
• Complying with federal, state, and company regulations and policies.
• Performing other clerical tasks, as required.
Medical Retriever/Remote
Advantmed - Houston, TX
April 2017 to August 2018
* Quality check of all documents sent from Medical Records
* Validate that the patients demographics match in the system with what is in the documents
* Validate whether there are records received within the range requested
* Validate if the image is clear
* If rejected, need to provide reason
* Must meet the departments benchmark quota for daily QC. Medical Secretary/Receptionist, Home Health Coordinator Niche Medical Group - Houston, TX
January 2016 to March 2017
* Making patients courtesy phone calls daily
* Answering phone calls
* Scheduling clinicians visits and evaluations
* Obtaining patients demographics information
* Submitting Authorization to Insurance in order to admit and treat patients
* Weekly filing
* Calling physicians offices to follow up and get orders signed and returned
* Scanning, faxing copying documents
Childcare Provider / French Tutor
Children's Learning Adventure - Houston, TX
March 2015 to November 2015
* Create and maintained a warm, secure and affectionate climate for young children.
* Nurture children and organize age-appropriate activities.
* Create a classroom environment conducive to learning.
* Teach introduction of the French language.
Sales Associate / Customer Service
Marshalls - Dallas, TX
June 2012 to December 2013
* Polite individual who recognized the role as service provider and maintained the utmost professionalism.
* Maintained a working knowledge of all merchandise in the store.
* Ranged up sales at register and bagged merchandise. Customer Service Representative
Sonatel Group Communications - Dakar
January 2006 to December 2007
Assisted clients with major telephone account matters
• Acquired recent accounts retained and ensured the proper functioning of existing accounts.
• Handled high volume sales successfully.
Customer Service Agent / Sales Representative / Call Center Rep PCCI Call Center - Dakar
September 2004 to December 2005
Served as the main source of contact, providing excellent service to customers.
* Called residential and business clients to create customer loyalty and sell products that best fitted them.
* Tracked and documented requests and ensured proper notation.
* Managed time effectively to meet required service level and customer satisfaction results. Education
Diploma in Medical Office and Billing Specialist
Ultimate Medical Academy
2016
Skills
• ICD-10
• Anatomy Knowledge
• ICD-9
• Physiology Knowledge
• CPT Coding
• Medical Office Experience
• Medical Billing
• Insurance Verification
• Medical Terminology
• Medical Records
• Records Management
• Microsoft Excel
• Medical coding
• Customer service
• HIPAA
• Medical scheduling Languages
• French
• Fluent
• EMR Systems
• Data Entry
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