Customer Service Data Collection

Diana Garcia Perez

***********@*********.***

**** * ***** ***** **, Phoenix Arizona 85027

Cell: 414-***-****

SUMMARY To obtain a position in an office setting with Scheduling or Claims processing duties where my varied skills and experience will be utilized. To work with a company that could offer growth and advanced opportunities.

SKILLS Customer Service, Testing Efficiencies, Active Listening, Verbal and Written Communication, Knowledge of several software, Excel, Microsoft Office, Word, Excel. Data Collection and Entry, Application Processes, Eligibility, Employee Training, Scheduling Medical Appointments, 10 key.

EXPERIENCE:

Wellpath May 2023-current/Medical Services Scheduler-Wellpath (Georgia Department of Corrections)

• Effectively schedules outside/Inside appointments with medical consultants, site/camp/prison medical teams.

• Coordinates transportation for inmates to attend physician visits, and surgeries.

• Knowledge of all specialties and meanings.

• notifies prisons in advance of emergent visits and next day visits for all appointments via email and phone calls.

• Courteous and helpful to our outside consultants.

• Closing and attending or not attend appointments/referrals.

• Notify proper staff of procedures that require preps or special instructions, and schedule appropriately.

• Creates a schedule for each day and notifies the unit staff of the scheduled appointments.

• Schedules on-site consultant appointments.

• Follows up on those who do not show up to reschedule if appropriate.

• Assists the Podiatrist and Optometrist while they are seeing patients.

• Provides a monthly report of all medical, consultant, and dental appointments for the clinic during the preceding month.

• Tableau server (calendar to schedule)

• Service now ticketing, worked tickets and solved issues.

• Wrote up tickets with calls from providers requesting appointments or changes to an appointment.

• Erma Software.

• Georgia Department of Corrections software

Claims Processor- Wellpath, March 2022-May 2023 Hendersonville, TN

• Processing medical, dental and vision claims

• HCFA, UB’s and ADA claims

• Working close with providers on correct billing addresses

• Resolved editing errors for several plans, over 300 groups.

• Process high dollar claims with accuracy.

• Solved complicated claims.

• Verifying an inmate is still incarcerated to receive benefits.

• Eldorado software (Kitty) software

• Cigna and Blue Cross, Medicaid, and Medicare claims

• Work on multiple screens.

• Work at home full time, private office.

• Maintained production and quality.

• Smart Data System (SDS) pulled claims and verified information is correct.

• Enter pricing on claims from SDS.

• Data entry, entering paper claims received.

• Working several reports, termed groups Cigna and Blue Cross Medical and Medicare claims.

• Completes accurate analysis of claim determination for payment or denial.

• Monitor claims inventory of assigned accounts and ensure turnaround and productivity.

• Benchmarks are met.

• Manual price claims based on specific rates.

• Audit peers work for continued cross training and education.

• Follow up on provider calls on status, explanation of payment, billing errors and refund requests.

• Verified claim data correctness in preparation for processing.

• Processed claims according to established quality and production standards and made.

• Corrections and adjustments to solve problems.

• Reviewed historical records to determine benefit eligibility for services.

• Researched medical claims for validity to resolve discrepancies.

• Analyzed contracts and claim systems to apply appropriate benefit amounts.

• Maintained comprehensive database for enrollment data, claim submission and payment.

• information.

• Examined claims, records, and procedures to grant approval of coverage.

• Processed claims for payment or forwarded to appropriate personnel for further investigation.

• Organized information by using spreadsheets, databases, or word processing applications.

• Retained strong medical terminology understanding in effort to better comprehend.

• procedures.

• Checked documentation for appropriate coding, catching errors and making revisions.

• Collaborated with fellow team members to manage large volumes of claims.

• Used insurance rate standards to calculate premiums, refunds, commissions, and adjustments.

Claims Examiner-Common Ground Healthcare, June 2015-March 2022 Brookfield, WI

• Validates information on all medical claims, investigates and resolves complex discrepancies.

• Processes claims in an accurate, efficient, and productive manner.

• Maintains departmental claims per hour and accuracy standards.

• Makes suggestions to improve the overall processes and procedures of the claims process.

• Deals with internal/external personnel in an effective professional manner, providing information.

• Requested and resolving the problem to completion.

• Processes high dollar claims with complete accuracy.

• Supports the claims team by participating in special project work as directed by the Claims Manager.

• Processing medical claims, adjusting claims, and working on more complicated claims problems.

• Resolved edit errors for several different queues.

• Contacting providers with question relating to charges

• Process on three monitors.

• Validate information on all medical claims and research and resolve discrepancies.

• Process claims in an accurate, efficient, and productive manner.

• Maintain departmental claims per hour and accuracy standards.

• Keep meticulous records of claims and follow up as required to maintain and complete.

• Follows the Hippa laws and compliance. Patient confidentiality.

• Effectively prioritize and organize each workday.

• Promote and maintain a flexible, cooperative, team environment.

• Make suggestions to improve the overall processes and procedures of the claims process.

• Possess analytical, problem solving and math skills.

• (Math skills include calculating discounts, Percentages, unit values, modifier, and multipliers

• Other duties and special projects as assigned.

• Answer questions from other processors and new employees.

• Reconsideration of claims and adjust corrected claims from providers.

• Provider calls, member benefits and claim status.

• Reduced $[Amount] claim down to $[Amount] based on meticulous records of actual.

• Researched and followed up on denied insurance claims.

• Investigated questionable claims to determine payment authorization.

• Paid and processed claims within designated authority level.

• Reviewed, evaluated, and adjusted claims to promote fair and prompt settlement.

ED Registration Specialist, Froedtert Hospital, July 2021-September 2021 Wauwatosa, WI

• Arrived new patients in the Emergency room.

• All Ambulance and Flight for life with trauma patients arrived.

• Registered patients in rooms

• Knowledge of Epic System, Connex, One Source and Forward Health

• Establishes accounts with accurate demographic and financial information to produce a clean claim to the third-party payor

• Ensures that all compliance forms are appropriately completed and documented on the patient's account

• Efficiently coordinates registrations of all patients.

• Data entry skills, Interpersonal skills, and excellent customer service skills.

• Interacts with patients and/or family members in all situations.

• Responded to incoming department phone calls and directed callers to appropriate team members based on need.

• Asked various questions from clients to obtain the information necessary for paperwork.

• Welcomed patients to facility and assisted with registration sign-in process.

• Adhered to HIPAA guidelines and maintained integrity of hospital policies and procedures.

• Worked with nurses and other clinic staff to process patients and direct them to appropriate departments.

• Carefully checked insurance information for benefits coverage and input pre-authorization added documents into the system.

• Registered patients for outpatient procedures and emergency services.

• Contacted insurance carriers to verify coverage, copays, and deductible information for patients.

• Explained forms and documents to patients, guardians, and family members, distributing copies and confirming comprehension.

• Maintained HIPAA compliance and integrity of hospital policies and procedures.

• Greeted visitors and ascertained purpose of visit, issuing needed credentials, and directing to appropriate staff or department.

• Politely and personally welcomed incoming clients and offered seats prior to beginning registration process.

• Scanned documents and insurance cards to include in patient charts.

• Collaborated with nurses and other personnel to process patient paperwork and direct to appropriate departments.

• Provided customer service support and advice on regulations and requirements regarding various registration programs.

• Protected medical information against unauthorized access, loss, or corruption by consistently following security protocols.

• Met needs of physicians and other treating team members with timely retrievals of patient medical records.

• Enhanced electronic records management systems to meet new needs and forecasts and demands.

• Developed in-service educational materials.

• Drafted statistical reports related to diseases treated, surgeries performed and hospital bed occupancy.

• Advised patients of monies required to be paid prior to services.

Claims Adjuster/Analyst/Processor, Broad-Path, July 2014-May 2015 Tucson, AZ

• Process medical, cob, vision claims HCFA UB'S

• Adjudicate claims that were processed in error.

• Verify what county and plan the member must process claim correctly.

• Aldera system

• Adjust Accumulators, deductibles, co-insurance, and co-pays.

• Request overpayments, load overpayments, void checks and reissue, clone claims.

• Work on two screens to process.

• Audited processors

• Reviewed, evaluated, and adjusted claims to promote fair and prompt settlement.

• Negotiated and settled claims according to information presented through reports, research, and data verification.

• Identified and obtained evidence to ascertain claim value.

• Investigated questionable claims to determine payment authorization.

• Gathered information from various third parties to determine claim acceptability.

• Completed required investigations on referred files within established times.

• Analyzed and audited open claims to calculate additional payments owed.

• Coordinated benefits while applying applicable deductibles, co-insurances and out-of-pocket costs.

Insurance Ops Sr. Associate, Dell, HC, February 2015-April 2015b Dallas, TX

• Processed medical claims for Medicare/cob claims.

• Resolving error edits

• Sending service forms and correcting them

• Amysis 6.0 and Macess software

• Researched issues and made quick decisions to achieve efficient and effective resolutions.

• Acted with minimal direction in self-directed capacities to resolve issues and implement strategies.

Call Center/Customer Service, Masterson Staffing, December 2013-January 2015 Brookfield, Wi

• Call Center, Receiving large volume inbound calls.

• Ordered products for customers.

• Entered credit card information for payment of product.

• Problem solving, refunds, replaced products that were damaged or not up to expectations.

Claims Adjuster/Data Entry and CNV Associate-Dell September 2013-December 2013

• Adjudicating Medicaid claims that were processed incorrectly.

• Examining claims for processing, problem solving

• Process Medicaid/Medicare and other secondary insurance claims.

• Corrected allowed amounts that were incorrect.

• Diamonds software

Assistant Manager-Crest House, Concepts, October 2012-September 2013 South Milwaukee, WI

• Reduced process lags by training employees on best practices and protocols.

• Recruited, hired, and trained new hires to optimize profitability.

• Replenished and arranged items to maintain appearance.

• Operated register handled cash and processed credit card transactions.

• Assessed team member performance and quality of care being provided to each person.

• Coordinated family tours to mitigate anxiety of admission.

• Arranged pre-admission tours to families to lessen anxiety of admission.

• Communicated with patients with compassion while keeping medical information private.

• Explained policies, procedures, and services to patients.

• Collaborated with multi-disciplinary staff to improve overall patient care and response times.

• Maintained communication and transparency with governing boards, department heads and medical staff.

• Maintained records management system to process personnel information and produce reports.

• Recruited, hired, and trained new medical and facility staff.

• Served as contact person and source of information to maintain good communication with clients.

• Answered incoming calls and recorded accurate messages.

• Gathered and sorted data for inclusion in reports and files.

• Checked stock to determine inventory levels and maintain office supply products.

• Executed record filing systems to improve document management and organization.

• Prepared correspondence, reports, and other documents in final formats with correct punctuation, capitalization, grammar, and spelling.

• Scheduled and coordinated meetings, appointments, and travel arrangements for managers or supervisors.

• Used scheduling software to delegate resources and manage calendars.

• Obtained signatures for financial documents and internal and external invoices.

• Coordinated repairs for office equipment to keep equipment functional and running.

• Assisted organizational efforts by filing, entering data and answering phones.

• Maintained front desk to provide positive first impression.

• Maintained positive working relationship with fellow staff and management.

• Received and distributed mail, letters, and packages.

• Handled incoming calls and directed callers to appropriate department or employee.

• Greeted guests and vendors to assist in navigating space.

• Answered phones and routed voicemails to respective employees.

• Coordinated support to facilitate general office operations.

• Broke down boxes for garbage and recycling.

• Assisted with set up for social events and food deliveries.

• Delegated work to staff, setting priorities and goals.

• Completed thorough opening, closing and shift change functions to maintain operational standards each day.

• Organized team activities to build camaraderie and foster pleasant workplace culture.

• Assigned work and monitored performance of project personnel.

• Recruited and trained new employees to meet job requirements.

• Remained calm and professional in stressful circumstances and effectively diffused tense situations.

• Reviewed completed work to verify consistency, quality, and conformance.

• Interviewed prospective employees and provided input to HR on hiring decisions.

Medical Claims Examiner- Health Markets/Mega Health and Life, September 2003-November 2010 Plano, Texas

• Processing PPO/HMO/ and Medicare products for multiple states throughout the U.S

• Memorizing a variety of different plans and Riders to ensure correct processing of claim.

• Adjusting claims for resolution

• Knowledge for renewal underwriting

• Worked closely on backend adjustments for completion per contracts.10 / 10

• ICD-9, CPT, HIPPA, HCSA coding and knowledge experience

• Reviewed and released payments to medical providers based on various state guidelines.

• Responsible for adjusting and verification of claims.

• Experience in processing HCFA'S and UB92's ADA’s for various insurance products including.

• HMO, PPO, POS, and Medicare Indemnity

• Adjusted claims for resolution.

EDUCATION AND TRAINING

American Red Cross CPR Certificate CBRF/WCTC - First Aid and Procedures to Alleviate Choking

WCTC - Administration and Management of Medications for CBRF WCTC - Universal/Standard

Precautions for CBRF

March 2023

- Fire Safety for CBRF Serving on the eye-to-eye committee at work

MATC

January 2012

EMT Certificate

January 2012

MATC

January 1986

GED

REFERENCES

References: upon request

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