Data Entry Customer Service
Resume:
Trina Redd-Elliott
O’ Fallon, IL 62269
************@*****.***
PROFESSIONAL SUMMARY
Well-trained Medical Office multi-tasking billing specialist, offering vast experience in medical operations, excellent interpersonal skills and educated on the HIPPA laws and regulations. Pursuing a role where hard work and dedication will be highly valued.
SKILLS:
Strong interpersonal skills and client relations
Locate/state health laws knowledge
Motivated team player
Natural leader
Personable
Excellent work ethic
Creative problem solver
Verbal and written communication
Customer service
Mediation capability
Employee relations
Quick learner
Medical terminology knowledge
Skilled problem solver
Active listening skills
People-oriented
Positive and friendly
SOFTWARE SKILLS:
Epic
IDX
Lotus 1-2-3
Microsoft Word
Microsoft One Drive
Excel
WordPerfect
Data Entry
10-key
QNXT
SUV
WORK HISTORY
BJC Healthcare July 2024-present
Patient Service Representative
Handles telephone calls from patients and staff; forwards calls requiring triage.
Verifies health insurance payment information and educates patients on the applicable regulations; collects payments and records data.
Performs receptionist duties with close attention to detail and professionalism.
Performs data entry of service charges, to include the assignment of diagnostic codes and the entering of all physician and clinic related charges.
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.
Respond to customer inquiries in a confident, timely and accurate manner.
Adheres to and participates in Company’s mandatory HIPAA privacy program.
Research caller’s issues/problems and find solutions.
Correct and refile claims with the insurance.
Take patient complaints, post discounts, set up budget plans, follow up with medical records department.
Aetna Better Health/CVS April 2024-July 2024
Customer Service Representative
Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
Guides the member through their members plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
Documents and tracks contacts with members, providers, and plan sponsors.
Engages, consults, and educates members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care.
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.
Uses customer service threshold framework to make financial decisions to resolve member issues.
Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
Triages resulting rework to appropriate staff.
Washington University School of Medicine
Self-Pay IBC II Special Billing May 2018-December 2023
Performed follow-up duties for third party payers to ensure timely and accurate payment of physician charges.
Worked directly with applicable departments, clients, or management to ensure accurate billing of physician charges.
Reviewed invoices, correspondence and remittances for rejections and verification of accuracy.
Utilized the payer websites.
Handles discounts, adjustments, and charge corrections.
Reviews remittance advises for rejection and accuracy of payment amounts.
Interacted with clinical department staff, assisted with special projects, and performed any additional duties as assigned by the manager/supervisor.
Ensured HIPAA Compliance.
Self-Pay IBC II Financial Assistance July 2017-March 2018
Reviewed financial assistance applications to ensure all required documents were provided.
Checked patient’s account to see if they were eligible for Medicaid and/or third-party insurance coverage.
Reviewed applications for self-pay credits and reviewed collection agency invoices for possible charity and process pro that can be applied to open self-pay invoices.
Reviewed collection agency invoices for possible charity and processed per departmental procedure.
Submitted financial assistance applications for management approval and notated patient accounts.
Worked on the group eligibility responses.
Opened and sorted financial assistance mail.
Performed back up duties for incoming calls as needed.
Self-Pay IBC II Patient Service October 2003-June 2017
Received and reviewed past due bills and made collections calls on patient accounts.
Processed inbound calls on ACD line to verify accounts along with insurance verification.
Collect payments from patients by check/credit cards.
Called patients and assisted in resolving patient outstanding balances.
Created budget plans.
Processed electronic insurance claims and processed e-commerce self-run-Medicaid verifications.
Provided MTC experience to different departments.
Worked on all Heart Care Institute accounts, Daily CAH reports, Monthly WUCA groups and reviewed Bankruptcy items.
Assist with special projects and performed any additional duties as assigned by the manager/supervisor.
Patient Services Centralized Registration July 1999-September 2003
Conducted patient interviews and reviewed schedules and screened appointments.
Communicated effectively with division and ambulatory patient offices to provide information.
Coordinated and communicated effectively with other internal departments (Ambulatory Services).
Initiated calls to patients to obtain missing data.
Facilitated the running, sorting and the distribution of Quality Control and Eligibility reports.
Reviewed and updated data via Barnes and Children’s transfer system.
Trained other personnel on the registration duties.
Insurance/Billing Collections March 1998-July 1999
Received all batch fee tickets from office visits and posted to IDX system.
Worked all edit lists by requesting missing information.
Distributed weekly edit list to all clinical supervisors.
Knowledgeable of diagnosis coding and billing procedures.
Processed work files in TES and billed secondary insurance.
Medical Records Clerk September 1996-March 1998
Processed and prepared patient charts for request orders and appointments.
Politely assisted callers with requests and organized medical records in the filing room.
Southern Illinois Healthcare
Medical Biller I July 1996-September 1996
Posted charges, payments and batching of office encounters.
Registered patients for appointments and updated insurance information.
Utilized ICD9 and CPT coding.
Jewish Hospital
Internship for Medical Billing January 1996-July 1996
Entered MC plus claims into computer.
Billed secondary insurance claims to companies.
Coded procedures to match claim diagnosis.
EDUCATION
St. Louis College of Health Careers-Certified Patients Account
Harris Stowe State College
State Community College
East St. Louis Senior High School-Diploma
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