Customer Service Representative
Resume:
KAREN D. LEE
*****.*.*******@*****.***
OBJECTIVE
I am seeking a challenging position that offers an opportunity for professional development and
potential for advancement and growth, where I can utilize my abilities and acquired experience.
EDUCATION
Westwood College – Torrance, CA
Associate degree in medical Coding and Billing-3.51GPA Graduation Date: October2015
o Awards: President Academic Award, Dean Academic Awards, and Perfect Attendance
o Relevant Coursework: Healthcare Billing and Reimbursement Systems, Coding and
Classification Systems, Medical Terminology, Computer Applications
RELEVANT SKILLS AND TRAINING
• Computer Skills: MSWord, PowerPoint, Excel, Access, 10-Key, AIMS, DRG system Five-9 Program, Slack,Zen-desk, Salesforce, Epic, eClinicalWorks, NetSuite
• QuickBooks
• Typing Speed: 35 WPM
• Customer Service, Grant Writing, Case Management
• ICD 9/10 and CPT Codes
• Claims Collection
• Collecting Copays & Balancing Drawers
Accounts Receivable
Updating Fee Schedule
Cashier
Input Registration
5 years Submission of Medical Claims
5 years Researcher of Denied Claims & Appeals
PROFESSIONAL EXPERIENCE:
Rite Aid/Elixir Solutions Mail Order Pharmacy
September 2023-February 2024
Mail Order Customer Care Representative (Remote)
Manage patients concerns with the objective of maintaining positive patient relationships by taking patient calls with complete positivity, empathy, and urgency; Created, confirm orders, and checked status of assisting orders. Responded to patients’ feedback via phone and emails.
Insight Global Staffing Agency/Samsara Networks Inc, Aurora, CO-January 2022-January 2023, Billing Support Specialist (Remote)
Process tickets (emails) in a timely manner using Zendesk ticketing systems, de-escalate any issues or concerns a customer may have, handle an upwards of 20+ calls and 20+ emails per day using a mac computer system. Assist customers with technical support requests when able. Responsible for finance and billing related calls, assist customers with paying their bills, invoice requests, supporting questions involving the self-service dashboard.
Stride Community Health Center, Denver, CO-October 2021-January 2022, Medical Biller/Coder (Hybrid)
Process claims, appeals, and denials, Submitting claims for reimbursement from the government. Reviewing and correcting patient demographic, member id, making sure primary payer & diagnose codes are in the correct line via Epic program. Call insurance companies to process & follow up on appeals and denials.
Kaiser Permanente, Denver, CO-July 2020-October 2021, AAR in Cash Remittance
Coded and posted Group and D Pay batches daily for all of Kaiser regions (CO, GA, HI, and NW) with monthly deadlines in place. Moved payments, processed refunds, transfers and reconciliation of D-Pay batches. Research members variable payments issues, handled live checks, Fed wires, and JVs and HI via FI accounting (SAP) Exception items. Processed incoming negatives, bank adjustments, PA payments and Chargebacks. Worked Cash remittance auto suspense report daily and managed my personal suspense report. Mailed transfer and refund forms.
La Care, Downtown LA, CA-April 2019-May 2020, CSC Service Representative II
Answered incoming calls from members, potential members, and advocates. Handled and resolves member issues or assists members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc. Provided essential information to members regarding access to care issues, handled coordination of care issues, benefits, Evidence of Coverage (EOC), Member Handbook, etc. and assisted members in using the self-service tools where available and verifying member eligibility. Performed the completion of PCP transfers. Processed plan partner changes. Processed payments for L.A. Care Covered members. Documented all calls in the system of record. Answered incoming calls from providers regarding general provider inquiries, claim status (prepayment), general program and administration questions for all lines of business including direct member request for I.D cards and PCP changes, triaged calls to appropriate units. Handled and resolved provider issues or assists providers in connecting with internal units. Provided essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC) and assist providers in using the self-service tools where available and verifying member eligibility. Performed the completion of PCP transfers. Processed plan partner changes. Handled complex calls as needed coordinates with Member Relations Unit to assist members with complex issues and coordination of care issues within Plan Partners. Assisted with new hire shadowing as needed and based on performance metrics. Processed payments for L.A. Care Covered members. Researched denied claims for resubmission and processed claim appeals. Documented all call interactions in the system of record. Assisted with the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communications for Cal-Medi Connect members and SPD members. Processed 20 plus claims daily, scrubbing, researching denied claims for resubmission and processing appeals of claims.
SCAN Health Plan, Long Beach, CA –October 2018 –March 2019 Member Services Advocate
Record all calls in IKA as applicable; Responded to internal and external customers in a timely and accurate manner. Assisted callers with Web Portal registration and utilization; Add requests for member materials. Respond to telephone inquiries and provided accurate, efficient, and courteous service. Excellent oral and written communication skills Researched billing & invoice problems. Empathy and passion working with senior and disabled members Great Interpersonal Communication Skills; Strong Verbal and Written communication skills. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA); Established and maintained positive and effective work relationships with coworkers, clients, members, providers and customers.
UCHealth, Aurora, Colorado August 2017-August 2018 Transplant Patient Access Liaison
Assists patients by determining their needs; Scheduled, rescheduled and canceled appointments through Epic program; Schedules patient appointments for physician and ancillary services in a timely and in an accurate manner. Take (100+ calls a day communicating with providers and clinical staff to properly update schedules and notify patients of schedule changes, and transfer to correct staff personnel. Relay messages to providers from patients regarding questions/symptoms and concerns; Entered and Verified Insurance; Follow-up on prior authorization for upcoming appointments and future treatment plans.
Anthem, Denver, Colorado March 2017-August 2017 Health Program Representative II/ Case Manager
Gathered and recorded appropriate member information in accordance with policies and procedures via telephone. Advising, counseling, reviewing applications and claims and/or responding to requests regarding business processes; Assists in the testing of new programs, enhancements to existing processes and new initiatives impacting customer service. Utilizes a variety of readily available guidelines; Obtains In-depth knowledge of programs, laws, regulations, and policies, include communicating knowledge to an extremely diverse customer base; Develops, examines, adjusts, reconsiders, recommends settlement of various types of
claims, receives and processes requests for authorization of healthcare services, supplies.
and benefits; Encouraged members to participate in the Care Management programs by providing information about the program, outlining program features/value and explaining available services; Advising and providing information on benefits and rights; Assisting individuals in developing needed documents and evidence required, or in
resolving errors, delays or other problems. Recorded details and utilize call scripts as needed based on client requirements; Directed member inquiries to appropriate clinical staff. Initiates referrals and manages consults from clinicians for participants registered in Care Management.
Gathered information from hospitals, health plans, physicians, patients, vendors and other.
referral sources: Contacted physician offices to obtain demographic information or related data as needed.
Cedar Sinai Medical Group, Santa Monica, California January 2014-January 2015
Patient Front Desk Clerk/Scheduler
Checked in with patients with a warm greeting in a pleasant and professional manner; Tracked patients in the reception area and communicated with them, as needed; Evaluated electronic chart data to verify all information has been received, completed, and signatures obtained. Obtained and scanned the patient's insurance card, and Valid Id, and other important required documents.
Ensured that proper authorization or referral was collected from the patient; Checking eligibility and benefits verification for treatments, hospitalizations, and procedures; Updating cash spreadsheets, and running collection reports; Enter all new patient demographic information into the computer. Setting up patient payment plans and work collection accounts. Marked arrival time of patients electronically and made sure that patients are seen on time; Reviewed the schedule status daily for the remainder of the week; Scheduled all appointments with the appropriate physician to ensure top quality care to patients.
References upon request
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