Customer Service Quality Assurance

Lawrence J. Guido

*** ********* ***. ************, ** 19460 (Cell – 610-***-****) *******@***.***

Award-winning professional with many years of proven progressive experience ranking as a top performer in customer-support management, focusing on the insurance industry. Recipient of numerous awards for outstanding customer service, exceptional management, attendance, and “going above and beyond.” Friendly team player with excellent communication and interpersonal skills needed to deliver superior customer service.

Core competencies

Customer Service/Support, Account Management, Client Relationship Management, Quality Assurance Control, Issue Resolution, Process Review and Development, Date Management, Financial Management, Personnel Management, Hiring, Employee Training Team Building, Performance Review, Microsoft Word, PowerPoint, and Excel.

Professional Experience

Children’s Hospital of Philadelphia 03/21 - 01/22

Patient Financial Services Interim Supervisor

Complete weekly management reports and send to appropriate personnel

oAR Trend Report

oCash Metric Report

oAR Metric Report

Complete and send the Transition Monthly Report to the PAC Manager the last week of the month

Complete and send the International Patient Report on the first of each month and send to Christine Deckhut

Complete and file the Home Care Statement Report by the fifth every month and file in the statement fold for our vendor to pick up and generate statement

Ensure the AR staff completed all rejected, hold, and incomplete claims on a weekly basis

Ensure the AR staff completes the department goal of working 10 credits weekly

Follow up with AR staff members if 60 invoices are not completed daily

Respond, assist, and resolve to any payor concerns from the AR staff.

Respond and resolve to any Billing concerns

Respond and resolve any Cash Posting issues

Respond and resolve any patient billing or eligibility issues

Respond and resolve any Change Health Vendor issues

Attend all payor conference calls

Respond to any requests from insurance representatives

Respond to any Pharmacy Management Requests

Respond to any Patient Account Coordinator requests

Approve any PPL requests that are sent to you – making sure proper department coverage is met.

Resolve any department personnel conflicts

Patient Financial Services Accounts Receivable\ Payable Representative 01/16 – Present

The primary focus of the account receivable is to provide consistent follow up on the open account receivables. Responsible to review payments received for services rendered and to determine contractual compliance. Responsible to provide payment disputes in a timely manner per payor, contractual and regulatory guidelines. Work with the interdisciplinary team and appropriate pre-certification coordinator to assure authorization issues are resolved

Perform payment disputes timely and in accordance with payor, contractual, and regulatory guidelines. Document all follow up activities into the patient’s medical record.

Review payments for accuracy. Identify and report all issues related to contractual compliance to management

Complete payor projects as assigned

Assist in obtaining/ maintaining department’s cash goal collection

Provide all Home Care reimbursement functions in accordance with CHOP

Reinforce all CHHC policies and regulatory accrediting agency guidelines

Preform necessary account collections when needed.

Document all patient account activity

Issue invoice refunds when necessary

Process credit card payments and refunds

Confirm patient insurance eligibility

Completed all assigned projects and audits

Proficient in Epic

Proficient in Fastrack

Pre-Certification,

Claim Billing / Coding

PrimePay

Benefit Supervisor / Trainer 01/15 – 01/16

Supervise 14 associates responsible for contracts, account reconciliation, billing, and eligibility. Ensure that all COBRA and Health Care Reform regulations are followed for federal compliance. Additional responsibilities include training, coaching, counseling, providing feedback on performance, and timesheet approval.

Monitor staffing resources and determine staffing requirements on current and anticipated projects.

Establish and cultivate relationships with clients by assisting with resolution of issues and managing client expectations.

COBRA/ FSA/ HRA Remittance Reconciliation on all accounts, Invoicing, Claims, FSA, HRA

Financial Reporting on Cash Reconciliation/ Collection/ New Accounts

Conducted formal training classes for all new hires on all benefit product products (Cobra, FSA, HMO, PPO, HRA)

Performed client presentations for all benefit products

Liaison for all special accounts

Trion

Cobra Supervisor 05/12 –01/15

Supervise 16 associates responsible for contract, account reconciliation, billing, and eligibility. Ensure that all Cobra and Health Care Reform regulation are followed for federal compliance. Addition responsibilities include training, coaching, and counseling, providing feedback on performance, and development, and timesheet approval.

Monitor staffing resources and determine staffing requirements based on current and anticipated client projects.

Establish and cultivate relationships with clients by assisting with resolution of client issues and managing client expectations. Continuously monitor business processes and systems and make recommendations for improving best practices.

Cobra Reconciliation on all Cobra Accounts on a monthly basis (644) to ensure proper remittance to the employer

PSC

Account Manager 3/08- 05/12

Manage/develop business in assigned territory, maintaining/expanding existing healthcare client accounts and prospecting for new accounts. Set up new accounts, prepare invoices, troubleshoot accounts, and prepare status reports.

Build and maintain strong, long-term client relationships through networking, meetings and phone contact.

Provide award-wining service by promptly following up with clients and resolving customer issues and concerns.

Train/mentor new associates, coordinate data mapping, analyze sales trends, and develop sales strategies

Aetna Incorporated Blue Bell, PA

Medicare Consultant 6/07 – 3/08

Provided critical support for Medicare service operations, including service analysis planning, testing design, development, implementation, and maintenance. Created vendor/customer specifications. Coordinated projects.

Performed market research and analysis, and developed informative presentations with recommendations

Interviewed internal and external customer to define and develop forward-looking information products.

Supervised all yearly Open Enrollment activity

HMO/PPO/AR Billing/Cobra/Enrollment Supervisor 9/04 – 6/07

Led a team on 30-35 associates responsible for plan administration and functional support. Evaluated customer accounts to ensure satisfactory product delivery. Coordinated research for managing delinquent client accounts. Performed audits on Cobra Accounts to ensure accuracy.

Monitored customer satisfaction against quality assurance, audits, and performance management initiatives

Trained associates, processed payroll, conducted performance reviews, and managed attendance/benefits.

Application Support Manager 10/01-09/04

Provided day-to-day support and expertise, including conduction interviews, performing independent research, and preparing fact-finding reports to develop innovative IT solutions for a wide range of operational problems.

Assisted project manager in transitioning Prudential Healthcare business into the Aetna Healthcare platform.

Acted as internal consultant/project lead to support IT and business area system-functionality inquiries.

Financial Account Receivable Unit/Cash Application Manager 7/00-10/01

Hired, trained, led, and directed a team of 15 employees responsible for accurate and timely cash control, payment processing within 24 hours, date-entry processing, and cash-batch operations. Promptly resolved Client-relation issues.

Evaluated inventory levels and workloads, and reviewed all refund recommendation prior to authorizations

Call Center/CCU AR Manager 04/98 -7/00

Hired, trained, and directed 35 employees responsible for mail processing, payment processing, and enrollment application activities Developed microfilm process and held full responsibility for resolving client-relation issues.

Supervised phone staff and maintained unit ASA of 30 Seconds or less and an abandon rate of less than 1%

Met all department phone-coverage metrics and ensured application of all checks to accounts within 24 hours.

Education – Associate Degree in Business

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