Customer Service Medical Records

Arthur (James) Wilson

** ******** *****• Atco, NJ 08004 EMAIL: ************@*******.*** • PHONE: 856-***-****

PROFESSIONAL SUMMARY

More than 20 years of business experience with extensive background in the customer services field to included healthcare. Utilize time management techniques effectively/efficiently in order to complete multiple assignments within a scheduled time period. Strong blend of technical, interpersonal and management skills, coupled by the ability to work well with individuals of diverse populations. Keys skill sets include:

Service Delivery

Property Damage Claims

EHR Super User

Electronic Medical Records

Disability Claims

Medical Claims

Microsoft Office Suites

HIPAA Compliance

Sales

Two Factor Authentication

Excellent Customer Skills

Problem-Solving

PROFESSIONAL BACKGROUND

AmeriHealth Caritas December 2022 – October 2023

Customer Service Representative

Responded to diverse membership and their providers as well as other customers in a timely, professional and courteous manner.

Made outreach welcome calls to new members and conducted Health assessment survey as needed.

Provided member education and assisted member with primary care physician (PCP) selection and assignments.

Assisted with access to care and wellness program.

American Automobile Association (AAA) South Jersey, Cherry Hill May 2015 – December 2020

Member Experience Specialist

Acts as a Sales representative and Customer Service Agents to AAA current and new members by delivering excellent customer service to the organization’s members.

Promoting the sales of associate and primary memberships; assisting members with membership issues; and carrying out necessary changes on existing memberships.

Provide assistant to members on all travel needs, including points of interest and accommodations.

Assist members in obtaining inter-American/International Driving Permits; helping members to obtain car rentals; and taking passport photos.

Advised members on the importance of getting total travel protection, including AAA Premier, Associate Membership, AAA Plus, and other products whenever necessary.

Xerox Company, Cherry Hill, NJ August 2010 – April 2015

Customer Care Specialist

Exceptional understanding of health and welfare benefits plans options and coverage.

Dealt directly with customers to resolve questions and problems concerning billing and other issues.

Provide policy benefits to our Insured’s/Beneficiaries in compliance with policy language.

Communicated appropriate options for a timely resolution.

Informed customers about services available and assessed customer based on needs.

Southern Jersey Family Medical Center, Hammonton, NJ March 2013 – November 2013

Health Information Medical Records Specialist

Managed and maintained patient medical records in electronic format

Prepared medical records for electronic processing

Protected patient information accurately; and handle the release of the patient’s health information in compliance with organizational policies and HIPAA compliance.

Understand EHR applications and the organization's work-flows.

EHR super user

Involved with the testing and implementation of the new EHR and scanning software.

Function in coordination with the Quality Assurance Compliance Officer to assure records are implemented and maintained

MetLife Insurance Company, Bloomfield, CT (Telecommuted) March 2007-August 2008

Long Term Disability Account Representative

Managed assigned caseload of long-term disability (LTD) and short-term disability (STD) claims.

Analyzed claims to determine eligible benefits through validation of policy status and policy language

Managed claims with longer duration and evolving medical conditions

Paid all covered claims accurately and timely

Managed both new claims and open claims equally and maintains decision times

Stayed abreast of ongoing trainings associated with role and business unit objectives

Arthur (James) Wilson Page 2

Reliance Standard Life Insurance Company, Philadelphia, PA September 1997-March 2007

Long Term Disability Claims Examiner

Prompt and thorough investigation of claims within departmental and regulatory guidelines.

Make accurate and compliant decisions related to LTD claims adjudication.

Thorough knowledge of insurance coverage claims handling guidelines, legal and medical terminology

Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information

Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis

TECHNICAL QUALIFICATIONS

Operating Systems: Windows 7, Windows 10

Software: MS Office Suite, Office Outlook 365

CERTIFICATION

Medicare and Medicaid Electronic Health Record (EHR) Incentive Program, Health IT Certification April 2013

Certificate in Meaningful Use

Department of Health and Human Services (HHS), Office of the National Coordinator (ONC) June 2012

American Health Information Management Association (AHIMA), Certified Healthcare Technology Specialist

Certified in Electronic Health Record (EHR) Implementation Support Specialist

EDUCATION AND TRAINING

Gloucester County College, Sewell, NJ August 2013

Practice Management and Electronic Health Record (EHR)

Camden County College, Blackwood, NJ February 2012

EHR, provisions of the American Recovery and Reinvestment Act and Physician Quality Reporting System

Health IT Certification on Meaningful Use Incentive Program March 2011

Meaningful Use of an Electronic Health Records

Lincoln University, Lincoln University, PA May 1985

Bachelor of Science in Business Administration

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