Customer Service Services Representative
Resume:
Soudary Phrathep
ad4p1r@r.postjobfree.com
Pinellas Park, FL. 33782
Objective
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Experiences
07/2021 - Current Provider Services Representative, Cognizant/ Molina Healthcare
● Provided customer service to providers regarding their claims and billing inquiries..
● Prevented key account losses by researching discrepancies and correcting problems..
● Processed claims and coordinated with providers, payers, and other third parties as necessary.
● Followed up with clients on outstanding documents or payments required for processing claims or services rendered.
● Developed relationships with new providers by providing guidance on how to use our systems, processes, and policies.
● Adhered to all applicable laws, regulations, standards, and procedures when interacting with providers.
● Verified accuracy of submitted documentation prior to processing claims or services rendered.
● Participated in training sessions as needed to stay current on industry trends and best practices related to Provider Services Representative duties.
● Ensured all provider contracts were properly executed before initiating services or payment arrangements.
● Analyzed reports generated from the system to ensure timely submission of claims and accurate reimbursement amounts.
● Referred unresolved customer grievances to designated departments for further investigation.
● Provided customer service to clients regarding their insurance coverage and billing inquiries.
● Initiating and maintaining effective channels of communication with service providers.
● Gathering, reviewing, and verifying all pertinent information relating to participating healthcare providers.
● Establishing and maintaining relationships with assigned healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service
● Answering questions from doctors' offices on benefits
● Gathering, reviewing, and submitting relevant documentation needed for claims processing
● Researched and responded to inquiries from clients regarding Medicaid coverage and benefits.
● Monitored changes in state policies and regulations concerning Medicaid programs and adjusted procedures accordingly.
● Checked claims coding for accuracy with ICD-10 standards.
● Assessed billing statements for correct diagnostic codes and identified problems with coding.
● Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
● Monitored changes in regulations affecting Medicare services provided.
● Cooperated with Medicare, Medicaid and private insurance providers to establish relationships and resolve billing issues
01/2022 - 01/203 Provider Configuration Team leader, Cognizant/ Molina Healthcare
● Conducted regular performance reviews to assess individual team member progress.
● Monitored daily workflow to ensure adherence to established policies and procedures.
● Participated in regular meetings with senior leadership to provide updates on team progress.
● Created and distributed monthly, quarterly and annual reports to management regarding performance.
● Tracked project schedules and encouraged teams to complete tasks on time while staying on budget.
● Managing healthcare provider accounts to achieve company strategies and goals
● Maintaining a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare
● Assisting help desk staff with more complicated benefit queries received., Lead a team responsible for provider configuration and credentialing processes
● Develop and implement processes to ensure timely and accurate provider data updates
● Collaborate with various departments to identify and resolve provider-related issues
● Train and onboard new team members, providing guidance and support
● Conduct regular quality audits to ensure compliance with industry standards and regulations
● Oversee the creation and maintenance of provider contracts and fee schedules
● Monitor and evaluate team performance, providing ongoing feedback and coaching.
● Established clear expectations for employees, providing guidance when needed.
● Offered training and support to keep team members motivated and working toward objectives.
● Delegated daily tasks to team members to optimize group productivity.
● Promoted to leadership position in recognition of strong work ethic and provided exceptional customer service.
● Assigned projects and distributed tasks to team members as per area of expertise.
● Helped mitigate and resolve data issues by analyzing situation and implementing appropriate solutions.
● Identified areas for improvement, narrowing focus for decision-makers in making necessary changes.
● Set specific goals for projects to measure progress and evaluate end results.. ad4p1r@r.postjobfree.com
Pinellas Park, FL 33782
01/2015 - 01/2020 Assistant Manager, CCTV Parts Plus, Tampa, FL.
● Assisting the store manager in day-to-day operations, ensuring smooth functioning of the store
● Monitoring inventory levels, conducting regular stock checks, and coordinating with suppliers to ensure product availability
● Handling customer inquiries, complaints, and resolving any issues promptly and professionally 01/2018 - 01/2019 Client Services Specialist, Zelis Healthcare Payments, Clearwater, FL.
● Incoming call from a health care provider to process a virtual payment card to pay a payer for medical bills from patients, workers, and dentists
● Follow HIPAA rules and regulations for information on account disclosure and the Level 2 verification process
● Support your provider with a complaint, deposit, or damage check
● Reconciliation of Payment to Explanation Of benefits/ payment reimbursement/835 Assist physicians in choosing the right payment method to receive a payment from insurance claims. 10/2005 - 01/2013 Poker Dealer, Derby Lane, Saint Petersburg, FL.
● Dealt cards and monitored players to ensure fair and appropriate play
● Calculated and assessed player's cards against house and competition to quickly ascertain gam e results and determine winning hands, player bets, and correct rotation of gameplay
● Monitored games for adherence to gaming laws and regulations, as well as house policies.
● Assisted guests in understanding the rules and regulations of various poker games.
● Collected gaming chips from players at end of each game session.
● Conducted chip exchanges as needed during shifts.
● Followed standard procedures for opening and closing tables. 02/2000 - 10/2002 Customer Service Representative Supervisor, AmeriNet, Clearwater, FL.
● Manage and lead a team of ensuring individuals are performing at their best and meeting performance targets
● Provide first-line support for customer escalations and complaints, ensuring timely and satisfactory resolution
● Develop and implement customer service policies and procedures to enhance overall customer satisfaction
Skills
● Knowledge and understanding of claims processes and data capturing.
● MS Outlook, Excel, and Word.
● Ability to work independently.
● Excellent verbal and written communication skills.
● Good problem-solving skills.
● Claims Processing
● Provider Relations
● Salesforce CRM
● HIPAA Compliance
● Insurance Verification
● Regulatory Compliance
● De-Escalation Techniques
● Medical Terminology Knowledge
● Problem-Solving Abilities
● Microsoft Office
● Analytical Thinking
● Problem Resolution
● Customer Relationship Management (CRM)
● Decision-Making
● Healthcare Regulations Knowledge
● Analytical Skills
● Computer Skills
● Organizational Skills
● Senior Leadership Support
● Policies and Procedures
Education
01/2009 Ultimate Medical Academy, Clearwater, FL.
01/2004 High School Diploma Northeast High School, Saint Petersburg, FL.
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