Service Representative Customer
Resume:
Gwenevere J. Turner
**** *.. **** ****** *** *N Broadview, Illinois 60155
Gwenevere Turner
Broadview, Illinois 60155
Objective
I am currently looking to continue my career with a company that will allow me to utilize my vast customer service experience. I would like to move into a position that provides me the opportunity to grow my knowledge; while allowing me to provide feedback on the improvement of processes. Professional Experience
North American Dental Group, Downers Grove IL.
October 2023-Present
Patient Service Representative
Answer incoming calls from patients to help them get enrolled and find dental appointments near them.
Change Healthcare Lombard IL.
October 2019-May 2023
Audit and Recovery Specialist-Refund Recovery
Interface and collaborate with various levels at the provider level to communicate outstanding inventory issues and attempt continuous follow-up through the order to case revenue cycle. Research, investigate, analyze, and resolve key issues at the provider and client level. Adhere to all escalation time frames and re-status inventory according to department guidelines. Engage key stakeholders and subject matter experts when the claim lifecycle is delayed. Managing an assigned portfolio of audit claims.
Gwenevere J. Turner
2035 S.. 15th Avenue Apt 1N Broadview, Illinois 60155 708-***-****
Out reach to facility or physician's office to obtain clinical signoff, refund pre-approval, or obtain additional information from the provider to the claim moving to refund. Hinsdale Orthopedics-Westmont, IL. (January 2018-April 2019)
Front Desk Coordinator
● Interview patients on site or via telephone and review history sheets filled out by patients to be scheduled for an MRI. Determines if patient's health history will permit an MRI scan.
● Schedule MRI appointment on a timely basis and appropriate to the type of scan ordered.
● Conduct pre-certification checks on all patients with commercial insurance and inform the patient regarding the pre-certification process.
● Return all phone messages/inquiries in a timely manner throughout the day and or before the end of the work day.
● Make CD copies upon request from the patient
● Call other MRI facilities, hospitals, doctors' offices to obtain previous medical history of the patient if needed.
Molina Healthcare Inc- Oakbrook, IL. (March
2016-December 2017)
Member Service Representative/Claim Service Representative
● Assist members and providers with inquiries on eligibility and/or benefits.
● Respond to customer questions and concerns via phone
● Review and provide details in reference to Prior Authorization approvals and denials.
● Maintain and exceed all monthly performance metrics.
● Extensive knowledge of medical terminology.
● Assist with Medicaid and Medicare members.
● Aid with medical Prior Authorizations.
● Educate providers on processing claims, authorizations, and appeals.
● Navigate through various systems to provide correct claims processing details.
● Assist providers with claim inquiries for the states of Illinois, North Carolina, Ohio and Michigan.
● Assist members and providers with portal support for all states.
● Assisted PIRR department with special projects when necessary. Byram Healthcare, Downers Grove, IL (June 2015-December 2015)
Customer Service Representative
Gwenevere J. Turner
2035 S.. 15th Avenue Apt 1N Broadview, Illinois 60155 708-***-****
● Handled a high volume of inbound calls for Byram’s customer service center
● Answered product questions, input orders, assisted the re-order team
● Provided updates to customers regarding order status
● Discussed primary and secondary insurances to determine product coverage Windy City Limousine, Elmhurst, IL. (August 2014-March 2015) Customer Service Representative
● Received inbound calls from clients looking to make transportation reservations
● Made outbound calls to clients to confirm vehicle reservations and any changes to their party’s transportation plans.
● Greeted clients at both Midway and O’Hare airports to easily guide them to their transportation Automated Health Systems, Schaumburg, IL. (January 2010-August 2014) Customer Service Representative
● Received inbound calls from patients and assisted in enrolling them with primary care physicians
● Contacted physician’s offices to assist patients in making medical appointments
● Made outbound calls to remind patients of their wellness checkups
● Entered enrollment forms received back from patients, and investigated forms that did not include proper physician information
● Helped with data entry in the Restriction Form department when needed Loyola University Medical Center, Maywood, IL. (April 2006-May 2009) Appointment Scheduler/Service Representative
● Scheduled medical exams in the Central Scheduling office for the Radiology Department using the Epic System
● Notified personnel when patients have arrived for testing Radiology tests, verified all insurance information by contacting insurance companies or through EPIC.
● Assisted in MRI, Women’s Health, CT and Emergency room scheduling departments when necessary.
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