Customer Service Benefit Specialist

Tarace Thomas

813-***-**** ● ************@*****.***

PROFESSIONAL EXPERIENCE

Coordination of Benefit Specialist Sr.

Quest Diagnostic, Tampa, FL 07/2021 – Present

• Validated primary insurance coverage for claims received attached EOBs while processing claims.

• Maintained accurate member COB information within Xcelys and COB Workbench application.

• Tracked states of MSP applications and approvals for accurate reporting to Finance, Conducted outreach phone calls and initial MSP eligibility screening to potentially eligible members, deeming members and their families.

• Verified Medicaid Eligibility for any paper applications received by WellCare

• Completed monthly presentation of team quality, goals and TPL avoidance.

• Submits Medicaid applications to state agencies on behalf of members, when requested by member

• Performed skills necessary to create a high-quality stakeholder experience, as reflected through acceptable quality audit score and productivity.

• Inputted and verified member Hospice eligibility.

• Provided Medicaid, Medicare and Low-Income (LIS) eligibility details to inbound caller and documents in Salesforce.

• Performed special projects as requested by management Claims Rep. Sr. 04/2015-07/2021

One Touch Direct, Tampa, FL

• Answered a high volume of calls from patients and doctor offices or their representatives, regarding patient and client bill balances, payment plans, credit card payments, patient and client pricing, rebilling insurance companies, and general patient and client concerns

• Processed adjustments, refunds, transfer bills, mail returns, and perform manual sales

• Evaluate and respond to all aspects of written billing inquiries, including but not limited to: billing insurances, updating invoices, reviewing EOBs

• Researched, troubleshoot, and resolved complex billing issues and complaints, taking all steps to resolve and ensure full resolution

• Maintained tracking log of all escalated patient and client correspondence, providing status updates to leadership as needed

• Performed all aspects of billing customer service as needed

• Navigated both Quest Billing System and the web

• Always maintained all Compliance and HIPAA regulations

• Acted as a back-up to all aspects of Billing Customer Service Rep duties as needed

• Made outbound calls to patients and clients, carriers, and/or any internal or external source as needed to resolve the issue

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• Managed inbound calls from patients and clients, insurance carriers, and/or any internal or external source as needed to resolve the issue

• Handled written correspondence to patient and client with the resolution if unable to resolve via phone

• Contacted Third Party carriers to follow up on denied and unresponded claims

• Analyzed and applied denials Process and review claims

• Researched inpatient and outpatient medical claims and make necessary adjustments.

• Assisted customers with enrolling in Medicare prescription drug plans

• Researched procedure codes for medical services for the allowable or billable amount for the services.

• Answered provider-related claims calls. I filed claims accordingly to the received date

• Entered Claims into the database from the 1500 claim form submitted by the provider

• Processed Claims related to Medicare, Medicaid, and Commercial Insurance Customer Service/Claims Rep III 12/2011 – 03/2015

Tampa Women’s Health Care, Tampa, FL

• Collected data to complete detailed financial reports for stakeholders and management.

• Enrolled Medicare/Medicaid recipients in plans bases on medical coverage needed. Executed billing tasks and recorded information in company databases.

• Developed rapport with clients to cultivate loyalty and satisfaction.

• Prepared billing statements for patients and verified correct diagnostic coding.

• Translated and interpreted medical billing codes with strong accuracy to enable swift payment from insurance agencies.

Specials Skills

• Over 10 years of healthcare experience from medical billing, claims, state reporting, authorizations, appeals and provider services.

• Computer Skills (Windows, Microsoft Word, Excel, Access, PowerPoint, Internet, and typing 60 words per minute)

• Outstanding reputation as a talented, dynamic, and confident individual who thrives on working in complex team environments.

• Adept at initiating and maintaining relationships with both internal clients and key personnel.

• Stellar communication abilities with an earned reputation for successfully achieving planned goals and objectives.

• I am an innovator, an individual who is highly motivated, ambitious, and enthusiastic.

• I am a strong advocate of perpetual self-development and look for new opportunities for hands on experience. I believe by using my skills and by acquiring new ones, I would be able to provide accurate information to our decision makers, as an institution we are better prepared to act without ambiguity and risk. EDUCATION

High School Diploma

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