Customer Service Claims Management

REBECCA VILLEGAS

**** ****** **** - ***** *******, TX 75052

Phone: 214-***-**** - Email: ******.****@*****.*** CAREER OBJECTIVE

Seeking my administrative skills and support with a progressive organization that will use my current education and career objective to assist in information technology and use complimented by excellent communication, medical terminology and customer service skills SKILL AREA

WORK EXPERIENCE

Method Claims Management Feb 2018 - Present

(Formerly known as Salus Claims Management & Caprock Claims Management) Claims Assistant & Administrative Support (Non-Subscribe), Lewisville, Texas

Assist in incoming and outgoing calls when needed

Call Providers request office notes, send out letters to Providers

Input DWC73/Work Status Report and Referral Request in the system for the Adjuster

Input all new Reports of Injuries, assign Claim Numbers and Adjuster for each Claimants

Call Employers for missing information

Train all the newcomers on our system and the processing

Scan Bills up for Billing Department for processing. York Risk Services Group Aug 2017 – Dec 2017

Claims Assistant (Non-Subscriber), Dallas, Texas

Retrieve Faxes for the Adjuster

Call Providers request Office Notes / DWC-73 / Chart Notes

Call providers for any follow up or restrictions for Injured Worker

Notate Claim File from the Office Notes, Work Status Report received and Return to Work Status

Pay Invoices

Excel

MS Word

Fee Schedule Knowledge

Customer Service

Utilize Microsoft Office / Internet Applications

Power Point

Outlook

10-Key

Multiple Phone Lines

Install Hardware

Troubleshooting /Replace Faulty Hardware

Zebra System

Data Entry

Medical Terminology

Knowledge on ICD-9 / CPT Codes

YCEa System

OccuSystems

WLT System

Baylor-Orthopedics Associates of Dallas Nov 2015 – Aug 2017 Referral Coordinator /POR, Dallas, Texas

Clinic for 19 Doctors, 16 Physician Assistance for 5 different facilities

Contact / or Schedule patient’s appointment as appropriate either Follow Up / or New Patient.

Transfer calls to appropriate department;

Message for Doctors and their clinical staff for patients rx refill, general notes

Fax patient’s orders, MRI/CT Scans or Physical Therapy scripts.

Work on systems Vision for appointments and Centricity for messages.

Work in EPIC System.

Verify Insurance and complete necessary paperwork for patient and insurance companies. Customer Service Agent/Dallas Water Utilities; 311 Oct 2014 - Oct 2015 Strategic Customer Services, Dallas, Texas

Customer Service Representative

Taking Calls / Transfer customer to the automated system

Assist the customer with payment arrangements

Inform the customer of their Total Balances and Due Date

Send a service order to have water turned on or disconnect

Assist customers with their user name and resetting their passwords

Assist customers with setting up autopay

Assist customers with any update information

Assist customers with new services / disconnect services

Send up internal notifications;

Interpreting policy and procedures and submitting accurate data into CRMS and SAP systems.

Comfortable with working with all levels of management. GREAT AMERICAN FINANCIAL (formally known as Freeman Administrative Solutions), Dallas, Texas

2007-2014

Third Party Administrative for non-subscribe workers’ comp on the job injuries / settlements SENIOR CLAIM PROCESSING TECHNICIAN

Organized and Assigned work

Claims Processing and Payment functions on large volumes of claims

Compose prepares, reviews and responds to correspondence;

Pick up the mail from Post Office / Stamped the mail in / Sort out / add claim number’s

Utilizes the company system(s) to identify the appropriate recipient of correspondence within or outside the company.

Answers and responds to inquiries and gathers information.

Maintains / purges documents per record retention guidelines and distributes file

Assist with claims numbers claims setup and entry,

Electronic imaging or indexing, statistical coverage verification,

Prepared entry of claims transactions

processing recovery and processing drafts and forms.

Print Checks for all Providers, Hospital, Clinical, Pharmacy and checks for all settlements, to Law Firms, to their Clients and to their family

Keep up with all the Prompt Pays making sure they are sent out on a timely matter.

Print out front/back of checks when requested.

Pull checks for Department.

Verified information on loss reports and expense and /or medical bills.

Assists claims staff in setting up appointments, keeping records, performing routine follow-up and ensuring that bills are sent out.

Provided support to claim departments in areas requiring specialized skills or knowledge.

Enters information into company system(s).

Assist in training in less experienced Claim Processors.

Performs all other duties as assigned – Flow Person for the company FAIR ISAAC CORPORATION, (FORMALY KNOWN HNC) COPPEL, TEXAS 2000-2005 Bill Review Company and Credit Score Company called FICO BILL REVIEW SPECIALIST II

Handled all UB-92 hospital applying service codes and res data. Apply capstone rules.

Effectively maintained balance, working with two major clients during transition, resulting in continuity and client satisfaction.

Initiated training procedures for new hires creating a more efficient department.

Broad based knowledge of medical fee guidelines in multiple states for UB-92 and HCFA 1500 Form.

Proficient at applying modifiers, ICD-9 Diagnosis, capstone rules and PPOs.

Operated consistently without re-evaluations on submitted claims.

Did QA information on other co-worker’s work.

INTRACORP, IRVING, TEXAS 1992-1996

Applied Workers’ Compensation Medical Fee Guidelines Medical Claims Reviewer

Applied and interpreted Texas Workers’ Compensation Medical Fee Guidelines.

Did assessment and recommendation for treatment with their Diagnosis.

Hospital UB-82 applied fair and reasonable ratio and the Per Diem Rates. CIGNA, IRVING, TEXAS 1986-1991

Applied Labor Laws and Workers’ Compensation

Auditor (1990-1991)

Reviewed correspondence letters from Insured Agents and TX Workers’ Compensation

Disputed rates, codes, and interchanging of labor.

Worked as a receptionist.

Auditor Clerical Support Clerk (1989-1990)

Prepared audit to be processed by Audit Examiner

Total monies on transaction card, balancing with premium registrar / claim runs.

Typed manual audit, delinquent letters, partial payment and audit related correspondence.

Log all audits from audit examiner on a control log for data entry.

Processed payment records and transmitted to TX Workers’ Compensation Insurance Facility Senior Typist (1986-1989)

Processed subscriber’s notices under the Workers’ Compensation Insurance Act.

Processed policies per underwriter’s instruction sheet per endorsements

certificates, billings, correspondence and other miscellaneous items. EDUCATION

ITT Technical Institute, Arlington, TX Sept 2014 - Sept 2016 Associate’s Degree in Network System Administrations W.H. Adamson High School, Dallas, TX Graduated - May 1985 V.O.E. – Vocational Office Education

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