James A. Keith

ad4vvv@r.postjobfree.com

**** ********* *** #*** ********, TX 75150 972-***-****

SUMMARY OF QUALIFICATIONS

Dynamic, results-oriented professional with over 10 years of experience in pharmacy benefit administration and health care insurance. Excellent interpersonal skills to forge strong partnerships and alliances.

HIPAA

ICD-10-CM/PCS

CPT/HCPCS

Data extraction

Scheduling

Verification

Registration

COB

Referrals

Medical Records

Legal Compliance

Workers’ Compensation

Terminology

Medisoft

SimChart

Claim Entry

Provider/Patient Relations

10-Key

MS Office

45 WPM

AHIMA CCA Certified

EXTERNSHIP EXPERIENCE

1ST Plus Emergency Care, Forney, TX 01/2020

Medical Billing Extern

Handled insurance verifications and reaching out to medical staff and patients; data entry EHR.

A Affordable Chiropractic, Mesquite, TX 01/2020

Medical Billing Extern

Data entry into EHR, handled inbound patient calls, scheduled appointments, and updated charts.

PROFESSIONAL EXPERIENCE

Medsynergies, Irving, TX 2014 - 2017

Client Services Representative

Responsible for Client Assist for 12 BC/BS Plans to ensure claims are processing per plan provisions

Liaise with providers to providing necessary overrides to allow adjudication of claims

Experience in RX claims, Rx Express, MSA systems Flowcast, GECB, GroupCast, Salesforce, ECW

Recognized as Employee of Month in January 2015.

Selected by the management team to train staff of new hires and serve as SME

Effectively cultivated customer trust by providing members and pharmacies with accurate information regarding new benefit plans to assure member and client satisfaction and accurate claims processing

Made outbound calls regarding member benefits. Investigated and resolved phone inquiries in a timely manner

Prime Therapeutics, Dallas, TX 2011 – 2014

Account Specialist

Utilize the Prime Call Tracking database to reply to patient inquiries as escalated by the Contact Center

Ensure timely response to inquiries. Resolved escalated complaints within a 24-hours

Communicated resolution to patients, clients, health plans and employer groups

CVS Caremark, Richardson, TX 2004 – 2011

Pharmacy Service Representative / Account Specialist

Verified benefits, interpretation of medical plans

Consistently demonstrated excellent customer service; Follow-through to achieve customer satisfaction

Provided excellent customer service to internal and external customers

Researched and resolved issues to allow the member to get the medications they need.

Serviced various therapy groups i.e. Growth Hormone, MS Therapy, Rheumatoid Arthritis, OA

Geico Insurance Richardson TX 2018-2023

Customer Service Liaison : Verified Coverage. Answered inbound calls Processed payments Researched and resolved issues.

James A. Keith

ad4vvv@r.postjobfree.com

Mesquite, TX 75043 972-***-****

Education/Training

Remington College 05/2019 – 01/2020

Medical Billing and Coding

4.0 GPA

Dean’s List

Perfect Attendance

Southwest States Theological Seminary 09/2005

Bachelor of Arts and Sciences

US Army Veteran 1985 – 1992

Honorable Discharged

Ahima CCA Certfied

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