ad26b5@r.postjobfree.com

813-***-****

TAMPA, FL ****7

Skills

Accounts Receivable

Bill Payment and Recordkeeping

Data Entry and 10-Key

Computer Skills

Microsoft Office

Data Management

Payment Processing

Data Entry

Customer Documentation Review

Invoice Preparation

Reservation Confirmation

Computer Reservation Software

Credit Card Payment Processing

Multitasking and Prioritization

Customer Data Confidentiality

Efficient and Detail-Oriented

Customer Account Management

Billing Inquiries

Inbound Customer Service

Remote Office

Computer Proficiency

Education And Training

Associate of Science:

Hillsborough Community College

Tampa, FL

Quanda Gibson

Summary

Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments. Hands-on professional offering a keen understanding of data confidentiality and HIPAA regulations. Highly trained

Medical Coder. Diplomatic customer service professional experienced in defining and analyzing customer requests to resolve issues. Over 15 years working in health care management.

Experience

Epic- Contact Center Agent

December 2023- Present

Handle inbound and outbound calls in a timely manner. Identify customer needs, resolve complaints and provide solutions. Handle escalation calls, process payment, Check reimbursement, Check re issue.

Centene - Billing Operation Specialist

Tampa, FL

08/2006 - 09/2022

Collaborate with internal team and external client to research and resolve any disputes or discrepancies in billed amounts and/or payment transactions.

Creating invoices and billing material to be directly sent to members.

Organized billing and invoice data, prepared accounts receivable and generated revenue reports to support audits.

Identified system and account issues to quickly and accurately resolve.

Reconciled data to identify anomalies.

Supported database performance by evaluating and resolving processing problems and designing database management tools.

Investigated and resolved issues to maintain billing accuracy.

Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.

Answered customer invoice questions and resolved issues discovered during invoicing and collection process.

Input client information into spreadsheets and company database to provide leaders with quick access to essential client data.

Posted charges, payments and adjustments.

Applied payments, adjustments and denials into medical manager system.

Submitted refund requests for claims paid in error.

Centene - Provider Data Management Analyst

Tampa, FL

08/2006 - 09/2022

Update provider and practitioners with claims payment and directory information.

Reviewed and updated account information in computer system.

Responded to daily inquiries and requests within mandated timeframe to meet deadlines.

Compiled, sorted and verified electronic data against hard copies to support quality control efforts.

Examined claims, records and procedures to grant approval of coverage.

Accurately processed large volume of medical claims every shift.

Organized information by using spreadsheets, databases or word processing applications.

WellCare Health Plans Inc. - Configuration Specialist

Tampa, FL

08/2006 - 09/2022

Performs accurate and timely provider research, verification, and analysis.

Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.

Resolves provider load issues within established documented processes.

Loading, approving/rejecting medical claims.

Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.

Entered procedure codes, diagnosis codes and patient information into Xcelys.

Precisely completed appropriate paperwork and system entry regarding claims.

WellCare Health Plans Inc. - Care Coordinator

Tampa, FL

08/2006 - 09/2022

Responsible for providing administration and department support for clinical care management, and field service coordinator staff.

Utilization Management

Facilitated Care coordinator throughout daily operations ensuring sound decisions established relationships and researched and resolved inquiries to ensure completeness and accuracy.

Produced and interpreted reports for missing or expired authorizations, non- members with authorization and multiple authorizations.

Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.

WellCare Health Plans Inc. - Member Engagement Specialist

Tampa, FL

08/2006 - 09/2022

Helped members resolve account problems and navigate internal systems to handle routine needs.

Enhanced productivity and customer service levels by anticipating needs and delivering outstanding support.

Consulted with customers regarding needs and addressed concerns.

Kept records of customer interactions or transactions, thoroughly recording details of inquiries.

Discussed ideas and strategies to improve operational efficiency, adding value and aiding business performance for continuous improvement.

WellCare Health Plans Inc. - Intake Coordinator

Tampa, FL

08/2006 - 09/2022

Requested authorizations for continuing care such as verifying insurance eligibility.

Effectively engage over the phone via both inbound and outbound hospital, provider offices and members regarding authorization for inpatient admissions, ambulatory services, outpatient services, consultation, and treatment services

Provide high quality, focused serving using knowledge of plan, systems, and procedures to meet or exceed member and provider experience.

Entered CPT procedure codes and ICD-9 codes, treating physician and facility from providers request for authorization.

Updated patient information on computer system to maintain billing accuracy.

Received inbound calls to obtain clinical information from providers to create authorizations and referrals.

Corresponded with hospitals and medical offices regarding incoming home health referrals.

Issued, gathered and inspected intake forms to confirm correct signatures and information.

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