Customer Service Care

VERNITA M. ROACH

**** ******** **. ****** ***, Texas 75068 ad5x7g@r.postjobfree.com 631-***-**** OBJECTIVE To obtain a customer service or medical representative position that enables me to use my skills in a professional environment that affords opportunities for growth. SKILLS &

ABILITIES

38 Years of Customer Service

Excellent Oral/Written Skills

Inbound/Outbound Call

Knowledge of Medical Terms

ICD-9 and CPT Coding

Medical Claims Processing

Detail-Oriented

Positive Attitude

Time Management

Interpersonal Skills

Ability to Resolve Complaints

EXPERIENCE August 2019 – November - 2018 October 2023 - Present Appointment Setter-CSR • Combustible Care Maintenance, Holbrook, NY

• Scheduled appointments cleaning services many States May 2022 - January 2022

Customer Care Representative PFS Group, Houston, TX

• Communicating with patients to help them resolve their healthcare accounts

• Resolving issues, setting payment expectations, arranging payments and requesting information from patients

March 2020 – October 2019

Customer Care Representative • Better Living Now, Hauppauge, NY

• Worked in a high volume fast past environment

• Answered phones, took orders, and opened new accounts

• Collected co-pays & co-insurances for services rendered

• Responded to customer emails for order status and updates

• Maintained product knowledge and educated customers on product availability

• Ensured compassionate and positive interactions with customers

• Resolved customer concerns and coordinated corrective actions August 2017 – December 2014

Senior Customer Service Representative • Arrohealth, Hauppauge, NY

• Monitored and audited Task Force Representative Aged Reports

• Queued time for healthcare providers, hospitals, and physicians to set onsite appointments to retrieve medical records for auditing purposes

• Followed Federal Government rules and regulations and HIPPA compliance PAGE 2

March 2011 – September 2011

Director of Operations • RCN Radio WNYG, Medford, NY

• Planned, directed, and coordinated daily operational activities of radio station

• Monitored and recorded daily shows operations.

• Hosted the radio show, “A Time to Share” for community affairs. May 2003 – November 1986

Medical Representative • Blue Cross Blue Shield of Florida, Jacksonville, FL

• Processed claims in a timely and accurate manner

• Researched and provided medical authorization needed for HMO Product

• Effectively worked to ensure authorization loaded on system in a timely fashion

• Navigated and used technology tools to efficiently process and resolve claims

• Researched and determined if claims were processed correctly

• Assisted provider/members in resolving suspended claim both written and oral

• Developed approaches to deal with claim situations without precedent

• Used the diamond system and coached on effective claim resolution process

• Identified trends and recommends improvement opportunities

• Audited all phases of inline of the product of HMO/PPO/Traditional contracts

• Assisted and trained team members to ensure accuracy of claims processing

• Audited multiple member/provider files to determine if claims were denied appropriately

EDUCATION International Miracle Institute, Pensacola, FL, 2016, Doctor of Theology International Miracle Institute, Pensacola, FL, 2014, Bachelor of Theology Florida College Of Medical & Dental Assistant, Jacksonville FL, 1980, Registered Medical Assistant

Edward Waters College, Jacksonville, FL 1985, Business Administration Miami Southridge Senior High School, Miami, FL, 1978, Diploma REFERENCES References are available upon request

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