Annie Gainey

Customer Care Specialist

Newport News, VA 23607

ad1wmi@r.postjobfree.com

+1-757-***-****

• Handle large call volume

• Inbound and Outbound call experience

• Effective communication

• Provide excellent customer care

• 9 years experience with customer care

• Claim Processing 2 years

Authorized to work in the US for any employer

Work Experience

Medical Claims Processor

Cognizant Technology Solutions - Remote

August 2022 to Present

• Challenge denials of claims by insurance companies.

• Organize health insurance paperwork.

• Audit hospital and provider charges.

• Negotiate with providers on patient balances.

• Review medical bills and determine proper payment.

• Review balance billing practices.

Medical Claims Processor

Cognizant Technology Solutions - Remote

August 2022 to Present

• Challenge denials of claims by insurance companies.

• Organize health insurance paperwork.

• Audit hospital and provider charges.

• Negotiate with providers on patient balances.

• Review medical bills and determine proper payment.

• Review balance billing practices.

Customer Service Representative

Ibex Global - Remote

November 2021 to July 2022

Customer Service Representatives will be worked directly with the customer to answer general inquiries, address concerns, and assist with requests about products and services across multiple lines of business. Th Projected a professional company image and provide superior customer service while working with customers through any of the customer contact channels. Your day to day will involve:

• Resolving coordination of benefits inquires by analyzing patient activity (including enrollment, third party liability, claims attachments).

• Having a comprehensive understanding of insurance coverage and being able to interpret and communicate accurate information.

• Thoroughly and completely documenting all customer interactions.

• Educating customers and dental professionals on eligibility, benefits, claims payment, and authorizations.

• Educating on the usage and benefits of self-service tools.

• Assisting members on gaining access to care by locating a network dentist or assignment to a primary care dentist.

• Directing inquires to necessary departments or individuals when the resolution of the inquiry is beyond the span of control for this role.

• Responding to customer inquiries in a courteous and professional manner.

• Researching and consistently providing accurate information to resolve all member and provider inquiries through verbal and written communications through all channels including phone, email, web portal, and chat interactions.

• Responding to and resolving internal and external complex customer inquiries.

• Booked appointments for clients

• Worked in the inbound call center

Claims Processor

WPS Health Solutions - Hampton, VA

August 2018 to March 2020

Claims Processor

• Process all Military and Veterans Health (MVH) claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), eligibility, and claims development.

• Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations.

• Calculate multiple Other Health Insurance (OHI) COB amounts using data from claims, such as the EOB or prior payment information given. Identify when to spend time with other departments based on guidelines.

• Process all claim types by determining corrective action to be taken on various types of errors pended by system and resolving interactive edits.

• Adjudicate specialty claims, including, but not limited to ambulatory surgery, skilled nursing, dental, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional based charges.

• Obtain and analyze claims data to determine specific problem areas including external communication to obtain data.

• Communicate with the inquirer to determine appropriate authorization or referral of services.

• Submit claims for adjudication, correction, payment, or review as appropriate.

• Educate providers on billing requirements of TRICARE to reduce claim problems.

• Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.

• Respond to inquiries using various forms of communication (written letter, telephone, web, or email) within time frames to exceed contractual standards.

• Collect and record data for Customer Service records and computer analysis.

• Inform supervisory staff of system problems when identified, researching problems to provide backup data and examples when needed.

• Answer inquiries concerning explanation of benefits CSR - Customer Service Representative

Randstad - Virginia Beach, VA

May 2016 to June 2017

High call volume with inbound calls and managed care plans help members decide what plan is best for them to suit their needs, offer great customer care, enroll members into health plans, make members aware of renewals and benefits of plans. Educate patient concerning Medicaid guidelines . Childcare Provider

Self employed - Hampton, VA

December 2014 to March 2017

Provide personal care for 2 children, feed, bath monitor etc. Account Representative/Customer Service

Portfolio Recovery Associates - Hampton, VA

May 2012 to October 2014

Responsibilities

● Handle large call volume inbound and outbound calls.

● Assist customers with choosing the best payment options to resolve delinquent accounts. Accomplishments

● I provided excellent customer service and problem solving. Skills Used

● Great communication skills in which listening is the major part of. Nurses Aide

Solutions Staffing & Home Health - Hampton, VA

March 2010 to September 2014

Responsibilities

● Assist clients with daily living and distribution of medication which is documented daily along with progress and all activities of client aide the client with physical and mental disabilities to make their lives as normal as possible.

Accomplishments

● Clients become like family members just because they are aged or disable does not mean that they don't deserve the best care and respect.

Skills Used

● Compassion

Education

High school or equivalent in Nursing

Norfolk Vocational Center - Norfolk, VA

Skills

• Microsoft Excel

• SharePoint

• Microsoft Word

• Microsoft Outlook

• Microsoft Office

• Windows

• Medical terminology

• HIPAA

• Medicare

• Analysis skills

• Documentation review

• Account management

• Typing

• Office experience

• Microsoft Powerpoint

• OSHA

• Phone etiquette

• Communication skills

• Insurance verification

• Computer skills

• Organizational skills

• Citrix

• Childcare

• Filing

• 10 key typing

• Care plans

• Customer support

• Managed care

• Medical billing

• DME

• Data entry

• Customer service

• Medical records

• Research

• Computer operation

• Cold calling

• Negotiation

Certifications and Licenses

First Aid Certification

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