Paulette Teh

***** ***** ******* **** *** ***

Canyon Country CA 91387

ad14lv@r.postjobfree.com

Summary:

a result oriented and professional Customer Service Representative with over 10+Years of extensive experience in a fast-paced call center environment and effectively communicating and solving problems for customers. Prior Authorization reviewer over 8 + Years check status date range, authorization number, facility requester verified codes forward to utilization department. Has 9+Years of experience in billing has resolved customer service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills. Batched third party bills, input into the system and provided maintenance

on patient accounts, which included reviewing, auditing, collections, researching and re-billing corrections and adjustments and verifying insurance coverage. Compare disputes with original requisitions and information from invoices and prepare invoices. Proficient in computer skills including MS Office Suite (MS Word, MS Excel, PowerPoint), and customer service.

Education:

● High school Diploma 1985

Susan Miller Dorsey High school

● Cert Computer Office 1 and 2 2002

● Cert Medical Assistant 2020

Skills:

● Customer Service (16+Years)

● Billing (13+Years)

● Pre Authorization ( UM Dept )

● Generated Invoice

● Collected deposits or payments

● Insurance eligibility

● Prepared monthly A/R reports

● Claim Processing

● Billing complaints

● Proficient in Word, Excel, PowerPoint

Experience:

Centene Health Care Support May 2023 to

Current

Provider services

● Responsible for handling 80 to 100 daily calls processed claims for Medicare/Medicaid, HMO and PPO insurance providers

● Contacts customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments

● Resolves customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills

● View and send claim to correct claim department enhancements includes claims guidelines

● Inputs benefit claim information for processing

● Provided maintenance on patient accounts, which included reviewing, auditing, collections, researching and re-billing corrections and adjustments and verifying insurance coverage

● As Technician, troubleshooted patient concern with supplies and any devices of new order of products given general information when needed

● Prepared monthly A/R reports for doctors

Integrated Resource INC July 2022 to May 2023

Onsite: SCE Southern California Edison / Solar Reviewer

● Review attachment and input into the system

● Recording details of inquiries of customer interactions

● Exceptional use of Excel database spreadsheet, Word, and Outlook

● Application solar system documents verify validate eligibility

● Send field engine review database battery (KW) system size

● Responsible forward load justification engineer review

● Review Residential / Commercial solar system approve or reject solar request

Health Net July 2013 to November 2021

Member Services

● Inbound – outbound Call Center

● Responsible for billing customer service

● Answered and appropriately directed 50 - 80 inbound & outbound customer service calls

● Generated invoices members responsibilities to pay out of pocket responsibilities

● Accurate data entry and administrative skills

● Responds to a high volume of incoming calls

● Determines charges for services requested, collect deposits or payments, or arrange for billing

● Eligibility processing and confirmation

● Keeps records of customer interactions or transactions, recording details of inquiries, complaints, or comments,as well as actions taken

● Verifies medical codes, completed pre-authorizations

● Prior Authorization reviewer check date range, physician request for authorization, provides pre authorization medical or pharmacy utilization approval or denial number check . Daily check folder for incoming faxes forward to the utilization department.

● Answers questions from members and physicians

● Verifies insurance eligibility

● LOB applications of medical inquiry (PGU Unit) Side by Side customer service trainer for new hire employees

● Exceptional use of Word, Excel, PowerPoint, and Outlook

Quest Diagnostics / Addeco Agency January 2013 to July 2013

Onsite : Billing Specialists A/R

● Well versed in Triple G, QBS and Screen 24 Billing software programs

● Determines charges for services requested, collect deposits or payments, or arrange for billing

● Keeps records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.

● Batched third party bills and input into the system

● Pull SLI’s of the third party and send to collections

● Keyed 300 – 400 third party billings daily

● Sorted mail for all third-party clients

● Resolves customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills

Starwood Hotel Resort July 2010 to June 2012

Reservation / Rep Call Center

● Responsible answering approximately 80 calls daily inbound calls

● Compares disputed merchandise with original requisitions and information from invoices and prepare invoices for

returned goods.

● Responsible going onsite front desk ( Anhiem or LAX ) within site area approved by upper management staff, check pending reservation welcome guest stay

● Handling escalated calls and expedited requests to front desk customer resolution.

● Supplied company line of product information to end caller’s request.

● Checks to ensure that appropriate changes are updated to resolve customers' problems

● Generated invoices if its members responsibilities to pay out of pocket responsibilities.

● Assisted in Customer Relationship Management training of new employees.

AIG Sun America January 2006 to January 2009

Financial Rep Call Center

● Responsible handling 90 to 100 calls daily supporting customer requests for portfolio service authorization forms for director's review approval

● Provided management division reports for daily, monthly, quarterly activities of service division

● Notified clients about guidelines on compliance regulatory issues

● Maintains accurate eligibility records for individuals and/or assigned employer groups. Process all enrollments;

plan changes, and dis enrollment transactions aging to determine delinquent accounts, membership reconciliation issues from premium issues

● Keeps records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken

● Processed trades before and after New York Market Exchange make available to caller’s allocation funds breakdown of performance

First America Warranty April 2005 to January 2006

Claim Resolution Rep Call Center

● Contacts customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments

● Responsible for handling 80 calls daily processed customer home warranty claims, which entailed answering questions on status of various accounts problems or complaints via telephone/written correspondence

● View and send claim to correct claim department enhancements includes claims guidelines

● Inputs benefit claim information for processing

● Maintains accurate eligibility records for individuals and/or assigned employer groups. Process all enrollments;

plan changes, and dis enrollment transactions aging to determine delinquent accounts, membership reconciliation issues from premium issues

● Checks to ensure that appropriate changes are updated to resolve customers' problems

● Arranged for license contractors to service homeowner’s transaction

● Worked with appropriate teams to develop, recommend, and implement corrective actions to A/R system

Medtronic / Volt Agency January 2002 – April 2005

Onsite : Medical Billing Tech Call Center

● Responsible for handling 80 to 100 daily calls processed claims for Medicare/Medicaid, HMO and PPO insurance providers

● Contacts customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments

● Resolves customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills

● View and send claim to correct claim department enhancements includes claims guidelines

● Inputs benefit claim information for processing

● Provided maintenance on patient accounts, which included reviewing, auditing, collections, researching and re-billing corrections and adjustments and verifying insurance coverage

● As Technician, troubleshooted patient concern with supplies and any devices of new order of products given general information when needed

● Prepared monthly A/R reports for doctors

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