Customer Service Data Entry
Resume:
Crystal Bluford-Bridgeman
**** **** ***** ****, ********, Ohio 43219
****************@*****.***
Summary of Qualifications
Business savvy, technically inclined, and team oriented customer service professional able to handle and resolve customer relation issues within a fast pace environment.
Knowledgeable team builder and leader effective at implementing training and supervising new hires and fellow employees.
Well organized and detail-oriented with experience in Credit and Collections, training, office support, data entry, billing and payment processing.
Researched and analyzed customer data from outstanding account balances to bring account current and/or provide payment plan options.
Broad knowledge of current healthcare, computer, finance, accounting and customer service industries.
Screening client applications for home energy assistance for the Ohio Development Services. Calling clients to get the necessary information to complete applications.
Ability to deal with problems involving all types of variables in a familiar context. Clear call center queue daily. Processing of medical claims for all lines business Medicare, Medicaid, MMP and Marketplace.
Resolves and prepares written response to incoming provider reconsideration requests relating to claims payment and requests for claim adjustments or to requests from outside agencies.
Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
Facilitate quarterly meetings with both Medicaid and Medicaid Medicare members. Contacted members by phone and or emails inviting them to attend the scheduled meeting. Typically meetings are held in our Community Based Organizations facilities in the Central, Northeast, and Southwest Ohio regions. For the meetings I invite staff, cbo’s and local agencies to attend and give a overview of their services that are provided to the community . These meetings are informal and informational to our members.
Microsoft 365
Microsoft Teams
SharePoint
Kronos
A/S 400 (AR 2000, DIS)
Distrack
Ez-Pickins
Spool Explorer/View
Ten Key: 6000 kph
Ricoh Multi-function printer/fax/scanner
Cisco Phone System
SAP
OCEAN
Caremark CVS
QNXT
CMS SCION
Experience
June 2022 to Current
February 2017 to June 2022 Molina Healthcare Services Columbus, Ohio
Assoc. Rep, Provider Inquiry Research & Resolution
Resolves and prepares written response to incoming provider reconsideration requests relating to claims payment and requests for claim adjustments or to requests from outside agencies.
• Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
• Completes appropriate documentation for tracking/trending data; reviews data to assist with identifying potential provider problem areas.
• Uses a variety of references to research and prepare healthcare provider information for loading into the health plan system/database; enters provider demographics, contract affiliation, or other data as needed.
• Interfaces with other departments regarding questions about provider configuration or other relevant provider issues.
• Composes all correspondence and appeal information concisely and accurately, in accordance with regulatory requirements.
• Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all appeals.
• Monitors each request to ensure all internal and regulatory timelines are met.
Due to a large backlog of reconsiderations, I volunteered to assist with the backlog.
I uploaded the reconsiderations first, then after some training worked the reconsiderations,
At the present time this is my full time job duty. I am more than glad to participate and collaborate with the Provider Inquiry Research & Resolution team.
June 2014 to February 2017 Molina Healthcare Services Columbus, Ohio
Member Services Claims Rep.
Respond to incoming calls from and member and providers.
• Achieve individual performance goals as it relates to call center objectives
• Engage and collaborate with other departments as applicable
• Assist with formal training needs of new employees as needed
• Seek out work during slow times to help ensure that department goals are met.
• Takes responsibility for keeping up-to-date and develops skills to meet new needs Pursues learning opportunities to develop and broaden skill set and expertise
• Knowledge of health care information terminology
• Good understanding of medical billing, and claims processing systems
• Extensive software skills & competencies, as well as Internet research abilities and strong communication skills
• Microsoft Office Suite knowledge (Outlook, Word, Excel, PowerPoint, Access)
Providing assistance for all states for the MMP members
August 2013 Ohio Department of Taxation Columbus, Ohio
To May 2014 Clerk 1
Intermittent employee prepared Ohio taxes for the 2014 tax season. Job included stamping, coding and adding.
June 2006 Cardinal Health Inc. Dublin, Ohio
To January 2013 Senior Credit and Collections Representative (Finance)
Collect at least 15% from all customers to reduce overall department delinquencies.
Maintain customer accounts, by answering questions by phone, email and faxes processing payments through many payment methods.
Reduce pharmaceutical distribution delinquencies by 90 million.
Reviewing financial statements for credit purposes. Creating spreadsheets for payment schedules. Referring customers to Credit Managers for credit limit increases or decreases.
Monthly reporting of total purchases. Assisted retail and acute pharmacy customers.
March 2001 Columbia Gas of Ohio Columbus, Ohio
To June 2006 Revenue Recovery Clerk (Credit)
Process and reconcile collection agency payment and reports.
Respond to request from collection agencies regarding customer accounts. (i.e. itemized statements and account balances.
Build effective relationships with internal and external customers, to achieve a win/win outcome.
Process customer accounts from the company database exporting to excel to create spreadsheets.
March 1997 Columbia Gas of Ohio Columbus, Ohio
To March 2001 Customer Service Representative
Process outbound and inbound calls effectively answering customer concerns involving billing issues, and emergency situations.
Process credit/collections, customer correspondence, accounting, problem solving by utilizing my excellent verbal and written communication skills to ensure excellent customer were achieved and company goals were met.
Balanced accounts monthly.
June 1984 Bank One Columbus, Ohio
To March 1997 Account Executive
Supervise customer service representatives
attend meeting, implement new procedures.
Assistant to branch manager
Assisted with interviews and employees reviews.
Process all banking transactions (internal and external customers.)
Reconcile and balance bank transactions also processed payments for loans.
Education
2004 Ohio Dominican University Columbus, Ohio
BS, Management Information Systems
Programming Languages: COBOL, Assembly, Level 5, C++
Systems Analysis and Designs, Networking and Communication
Business Management, Accounting and Finance.
I Learn Microsoft Excel classes
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