Kiante Roach

Upper Marlboro, MD *****

ad39q1@r.postjobfree.com

+1-301-***-****

Work Experience

CSA - Customer Service Advisor

WSSC Water (Contractor) - Laurel, MD

January 2023 to December 2023

• Primary voice of WSSC Water customer service.

• Responsible for responding to all non-emergency customer inquiries regarding water and sewer concerns, service requests and billing & accounts.

• Essential Functions Delivers excellent customer service by responding to inquiries and questions about customer accounts and services in a timely, accurate, and complete manner

• Reviews and analyzes complex residential and commercial property billing and responds to customer questions or complaints by modifying customer accounts and billing.

• initiating and explaining complex adjustments customers Interacts with the customer to schedule and process meter readings.

• process electronic credit card and check payments.

• initiates or removes penalties/fees and calculates new balance processes name/address change and final bill emails, initiates refunds and Dispute Resolving Board (DRB) requests.

• provides information to customers regarding Bay Fee Exemption or Customer Assistance Program

(CAP) Maintains contact and appropriate follow-up with residential and commercial customers through multiple channels including phone, face-to-face, e-mail, fax, etc.

• Cultivates effective customer relationships that foster customer satisfaction Grants bill extensions and assists with bill collections by initiating turn/offs for nonpayment

• Identifies and troubleshoots technical issues as appropriate including handling inquiries and resetting customer passwords for iCare

• Stays well-informed on WSSC Water business operations such as daily water main breaks to better service our customers Educates and advises customers on water and sewer tips such as identifying leaks on property (dye test, meter reading, etc.) Staffs One-Stop Shop Case Manager

Contractor Department of Navy - Washington, DC

October 2020 to December 2022

Analyzing historical award cases, researching and interpreting historical regulations and policy guidelines

• Resolving questions/ inquiries from Congressional offices to include submission of award recommendations via DON TRACKER.

• Preparing, Filing and processing 1130 cases to be put before the CNO Awards board for review

• Reviewing researching and crafting direct responses to inquiries from Veterans families and Congressional office

• Maintain close liaison with NDM Navy Personnel Command Navy History and Heritage Command and the Office of Legislative Affairs

• Provide technical guidance and assistance to delegated awarding authorities NPC and Retired records

• Providing direct support via the main DSN-35 phone line and giving referrals and/ or direction to matters that are not under our direct purview

• Monitor CNO Awards email account for incoming request Benefits Enrollment Specialist (customer Service)

BlueCross BlueShield-Elite - Washington, DC

October 2017 to September 2020

• 100-200 calls a day or more

• Processed benefits Enrollment, Terminations

• Responds to telephone inquiries and written inquiries from subscribers, group administrators, providers, brokers, medical professionals, and internal personnel regarding contracts, benefits, and claims processing

• Help client interpret contract language for the purpose of providing benefit utilization and limitations

• Executes enrollment transactions in accordance with contractual and medical underwriting guidelines

• Determine need for managed care initiatives, and to administer all types of service to a policyholder

• Examines claims to identify key elements, and processing requirements

• Researches, investigates and resolves pends created by the processing system

• Calculates deductibles, maximums, and determining resolving, reporting, and following through on overpayments, underpayments

• Apply an expert ability to analyze client need by current product mix, risk assessment, and revenue impact

• Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention Financial Specialist/Collections

Conifer Health Solutions (Healthcare Scouts) - Annapolis, MD July 2016 to September 2017

• Flexible spending accts (FSA) and Health saving accts (HSA)

• Researches accounts and performs quality assurance review of certain customer bills to interpret payment history, adjustments, and activity such as name changes and final bills

• Small balance write off

• customer service regarding collection issues

• Take payments by credit cards and checks

• Process customer refunds

• Process and review account adjustments

• Resolve client discrepancies and short payments

• Monitoring and maintaining assigned accounts

• Processes and responds to a various routine and moderately complex billing adjustments, inquiries, and routine correspondence

• Account adjustments

• Customer reconciliations

• Processing credit memos

• Weekly and monthly reporting

• Monthly Delinquency notices

• Resolving customer disputes as they pertain to payment of outstanding balances that are due

• Premiums

• Payments

• Made customer calls

• Pre -authorizations

• Appeals

• Claims

• Cpt codes, icd-9 and 10 codes

• Update member's information

• Help providers with member policy quotes for procedures entering data in accurate manner

• Works with patients to explain coverage amounts provided by their insurance policy, so they can understand why some procedures may be covered, while others are not.

• Work cordially in a team and participate in meetings, sharing ideas and information. Insurance Verification Specialist/ Medical Records Financial Health Strategies - Gaithersburg, MD

May 2015 to June 2016

Verifying patient insurance coverage demographic information when registering them for the service or program. Schedule appointments, collect co pays, reimbursements.

• Ensure necessary procedures are covered by an individual's provider. Reviewed provider's disputes and appeals.

• Scanning and uploading files to create digital copies

• Responsible for entering data in an accurate manner,

• Retrieved patients records both paper and electronic

• Update patient benefit information in the organization's insurance system and verify that existing information is accurate.

• Spend extensive amounts of time on the phone with insurance companies.

• Serves as a valuable resource to patients, providing them with pertinent information regarding their coverage.

• Works with patients to explain coverage amounts provided by their insurance policy, so they can understand why some procedures may be covered, while others are not.

• Helps patients arrange payment for services that are not covered by their insurance companies, discussing different financing options to fit their budgets.

• Perform light administrative duties as needed

• Identify important patient and demographic information that are missing and inform client about them to avoid claim processing issues with the insurer.

• Establish contact with the ordering physician's office or customer service department to resolve issues concerning missing vital information from patients scanned requisition record.

• Ensure timely processing of benefit information and seek assistance from management when necessary.

• Work cordially in a team and participate in meetings, sharing ideas and information.

• Remove and forward discharged patients' files to the Business Office where they are processed.

• Request pre-certification and benefits on all patients, both inpatients and outpatients for surgery. Why some procedures may be covered, while others are not.

• Helps patients arrange payment for services that are not covered by their insurance companies, discussing different financing options to fit their budgets.

• Perform light administrative duties as needed

• Identify important patient and demographic information that are missing and inform client about them to avoid claim processing issues with the insurer.

• Establish contact with the ordering physician's office or customer service department to resolve issues concerning missing vital information from patients scanned requisition record.

• Ensure timely processing of benefit information and seek assistance from management when necessary.

• Work cordially in a team and participate in meetings, sharing ideas and information.

• Remove and forward discharged patients' files to the Business Office where they are processed.

• Request pre-certification and benefits on all patients, both inpatients and outpatients for surgery. Perform verification of Medicare coverage and limits on all Medicare accounts of inpatients. Also Medicaid accounts

• Acquire billing information by verifying Worker's Compensation accounts and MVA.

• Access different hospital systems for Patient Accounts

• Verifying Patient Coverage through Transunion or calling Insurance companies Account Representative

Kaiser Permanente (Contractor) - Rockville, MD

October 2013 to October 2014

• Research and review outstanding account receivables.

• Review, update and correct patient information using various applications.

• Follow-up (in-bound and out-bound phone calls, e-mail, regular mail) with insurance companies/patients regarding claim/payment status through our practice management system and reporting tools.

• Research and obtain necessary documentation for insurance companies to process outstanding claims.

• Organize and prioritize work to make sure projects are completed in a timely and efficient manner.

• Identify trends and issues; summarize results and escalate to supervisor. Enrollment & Billing Technician I/ Call Center

BlueCross BlueShield-Elite - Washington, DC, US

July 2010 to March 2013

• Accounts are accurately and timely enrolled, billed, and reconciled so that the system is correct and the client is satisfied.

• Interact and coordinate with accounts, subscribers, sales, underwriting, finance, systems, other Blues plan account installation, HMOs and other internal service units of CareFirst.

• Enrolls subscribers and dependents for all business in a timely manner to meet the corporate objective of timely and accurate ID cards.

• Makes benefit changes and additions.

• Performs basic billing and account reconciliation, as well as processes terminations, cancellations, and other forms of subsequent enrollment activities. If assigned to section service functions, handles phone and written inquiries from GA's, brokers, and service related to enrollment & billing.

• Social Security forms, verifying and correcting information.

• Verifying forms information to what's in computer system.

• Call Center Inbound Answered 100-200 calls a day from customers about status or general questions

• Receive calls from applicants, beneficiaries, providers and facilitators

• Actively listen to calls to determine the reason for the call and how they can be assisted

• Determine the appropriate action to take to resolve the caller's issue.

• Communicate with internal and external customers to meet callers need.

• Document calls and resolutions using all appropriate systems.

• Maintain client privacy

• Process and document future, current and past due transactions

• Verify member's eligibility

• Request backup information or documents as needed to bill, rebill and credit issues

• Complete correspondence responsibilities including written letters/forms and telephone contact Education

High school diploma

Associate's degree in Accounting

Associate's degree in Healthcare Administration

Skills

• Customer service

• Sales

• Typing

• Cash handling

• Inside sales

• Telemarketing

• Account management

• Windows

• Customer relationship management

• Clerical experience

• CRM software

• Google Suite

• Leadership

• Accounts receivable

• Fair Housing Regulations

• Account Reconciliation

• CPT Coding

• General Ledger Accounting

• Yardi

• Accounts Payable

• QuickBooks

• Financial Report Writing

• Calendar Management

• Case Management

• C2m

• ICD-9

• Bookkeeping

• Records management

• Calendar management

• Google Docs

• Microsoft Publisher

• Accounting

• Medical records

• Order entry

• General ledger accounting

• Financial report writing

• Analysis skills

• Microsoft Access

• Salesforce

• Medical terminology

• PeopleSoft

• Medical coding

• Document management

• Accounts payable

• SharePoint

• ICD-10

• Microsoft Office

• Medical office experience

• CPT coding

• HIPAA

• Insurance verification

• Phone etiquette

• ICD coding

• Documentation review

• Data collection

• Data analysis skills

• Negotiation

• Medical Billing

• Financial Analysis

Contact this candidate