Customer Service Representative

Mary V Richburg

518-***-**** ************@*****.*** Sacramento, CA,95831

SUMMARY

Over 15 years of customer service experience

Proficient in Microsoft Office (Excel, Outlook, PowerPoint, Word), medical healthcare software programs for government (Medicare, Medicaid, Child Health Plus, Covered California) and commercial health plans (EPIC, NextGen, EHR/PM)

Outstanding verbal communication and strong organization skills

Supervisory experience includes hiring, training, performing employee evaluation, processing payroll, budgeting and adhering to company’s policies and procedures

Works well independently as well as with others of diverse backgrounds

PROFESSIONAL EXPERIENCE

Health Information Technician RC Staffing/Sutter Medical Center, Sacramento, CA 04/2023-02/2024

Performed scanning of the paper health information record into the electronic health record following established guidelines

Sorted or classified electronic medical records according to guidelines such as content, purpose, user criteria.

Performed qualitative and quantitative analysis of scanned document images to assure accuracy and legibility maintained.

Protected the security of medical records to ensure that confidentiality is maintained.

Patient Service Representative Elica Health Center, Sacramento, CA 09/2022 -11/ 2022

Handled outbound and inbound calls from patients, other medical offices, patient family members and hospitals

Triaged patients to determine appropriate route of care

Scheduled patient appointments via inbound and outbound calling efforts

Transferred patient calls with complex inquiries; Took accurate messages and delivered them to appropriate staff.

Documented patient complaints; Maintained patient confidentiality

Eligibility Insurance Enrollment Specialist One Community Health, Sacramento, CA 11/2013 – 07/2019

Interviewed, evaluated, established and processed healthcare insurance clients in a nonprofit environment

Registered new patients by scanning documents and entering in data from applications

Interpreted and explained information including eligibility requirements, application details, payment methods, and applicants' legal rights.

Obtained prior authorizations for patient referrals, kept records of assigned cases, and prepared required reports.

Compiled, recorded, and evaluated personal and financial data to verify completeness and accuracy.

Utilized EPIC, SEMAS/SHARE programs to update and maintain patient health records

Government Customer Service Representative Capital District Physician Health Plan, Albany, NY 09/2009 – 09/2013

Handled Medicare, Medicaid, and Child Health Plus Plans in a call center environment

Processed and maintained client information in database to include enrollments, terminations, and applicant updates

Answered external and internal customer’s questions regarding billing and eligibility concerns

Customer Service Representative Fusco Personnel (First Health), Albany, NY 08/2008 -08/ 2009

Provided excellent customer service in a pharmaceutical insurance entity (First Health)

Fulfilled customer needs in eligibility, enrollment, billing, and claims in a call center environment

Conferred with customers by telephone or in person to provide information about products or services, took or entered orders, canceled accounts, or obtained details of complaints.

Determined charges for services requested or arranged for billing.

EDUCATION

Associate’s Degree in Business Administration Albany Business College Albany, New York

Microsoft Office Certificate

Adult CPR Certificate American Red Cross

ADAP Counselor Certificate California Department of Public Health

Covered California Enrollment Specialist Certificate Covered California

SEMAS Certificate California Department of Healthcare Services

EPIC Certificate EPIC

Contact this candidate