Customer Service Provider Data
Resume:
Renee L Goggins
Gibsonton, FL 33534
Phone: 813-***-****
************@*****.***
Objective
Self-motivated, detail-oriented, customer-friendly individual who wants to grow with a company. Provided a high level of customer service and client relations based on outstanding communication and interpersonal skills
Summary of Experience
Great ability to managed patients’ information
Outstanding in acting as a liaison between medical facilities and insurance carriers (HMOs, PPOs, Medi-cal, Medicare)
Strong motivated and dedicated to the job
Handle claims with different Insurances
Ability to read and interpret EOBs, and face sheets from medical facilities
Setting up new patients’ accounts
Verification of insurance (Medi-cal as well as other insurances)
Posting payments
Knowledge with insurance authorizations and denials
Correct denial claims with correct information and re-submit claims
Submit electronic claims and paper claims (primary insurance or secondary insurance)
Follow up on unpaid claims as well as old claims
Employment History
09/2021 to Present United Health Group {Optum} Tampa Fl
Provider Data Specialist
Performed credentialing and re-credential activities for health plans according to plan speciation.
Created and maintained credentialing les consistent with NCQA standards.
Entered credentialing data into provider data management system and maintain 98% data accuracy.
Provided support to providers, integrated delivery system, Network Coordinators.
Arranged set-up for group a liations, investigate, analyze, and manage routine information on providers in
multiple states.
Contacted providers via telephone or in writing to verify data submitted, and enter data into systems.
Performed payment and other provider-type analysis on an ad hoc basis.
Update provider information using Microsoft Excel.
Provider Data Specialists are also responsible for overall provider contract and amendment loading and
processing using various databases.
Load new provider demographic information, and perform provider data maintenance.
Perform speci c updates in NDB, NICE, and ProBase.
Call provider o ces to gather and record correct information to maintain a high level of accuracy in all United
HealthCare systems
10/2019 to 09/2021 Favor Techconsulting LLC Tampa, FL
Customer Service Advocate
Serve as the first point of contact for the Department of Veterans Affairs (VA) to address all incoming customers’ needs and provide assistance and/or escalations whenever necessary
Answer incoming phone calls daily from customers and identify the type of assistance the customer needs
Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
Contact care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed
Assist customers in navigating UnitedHealth Group and/or VA CCN websites while encouraging and reassuring them to become self-sufficient in using our tools
Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
12/2016- 06/2019 Iron Bow Technologies Tampa, FL
Customer Services Specialist
Provide outstanding customer service and education regarding benefit utilization and limitations.
Assist in the need for managed care initiatives.
Appropriate documentation of all client interactions according to established procedures.
Demonstrate best practices and learned skills in order to assist the team with improved quality, productivity and performance metrics.
Learn information required to effectively provide information to clients as it relates to inquiries concerning pre-existing conditions, knowledge of policies and riders, identification of other insurance and coordination of benefits, benefit exclusions, administration of direct pay, credit card payment, debit accounting and other enrollment and billing transactions.
Reply to inquiries via telephone, e-mail
Use available resources efficiently to assess the customer’s issue and recommend valid solutions
Escalate unresolved issues to the appropriate Program Manager or supervisor
Record details of each customer interaction and any actions taken
Follow up on any customer issues requiring additional research
Maintain adequate knowledge of claims.
08/2015 – 10/2016 Quest Diagnostics Tampa, Fl
Billing Customer Representative
Answer a high volume of calls from patients or their representative, regarding patient bill balances, payment plans, credit card payments, patient pricing, re - billing insurance companies and general customer concerns
Process adjustments, refunds, transfer bills, mail returns and perform manual sales
Evaluate and respond to all aspects of written billing inquiries, including but not limited to billing insurances, and updating invoices
Research, troubleshoot and resolve complex billing issues and customer complaints, taking all steps to resolve and ensure full resolution
Maintain tracking log of all escalated patient correspondence, providing status updates to leadership as needed
Ability to perform all aspects of billing customer service as needed
Thorough navigation of both Quest Billing System and the web
Maintain all Compliance and HIPAA regulations at all times
Ability to work in a fast-paced environment
Ability to meet quality standards
Ability to meet production standards
Ability to handle other projects as assigned
10/2013 – 08/2015 One Touch Direct Tampa, FL
Customer Services Representative
Provide excellent customer service
Answer customer inquiries or complaints
Receive and process applications and payments to the City for services rendered
Open and close accounts and post payments
Calculate, balance, and reconcile cash drawers, cash receipt records and spreadsheets
Prepare correspondence and perform various other clerical and administrative duties.
Complete special projects as assigned.
06/2008 - 05/2013 Joyland Daycare Junction City, KS
Provider/Owner
Owned and operated a child care facility
Maintained records relating to personnel, resources, finances.
Developed extra-curricular activities for children.
Communicated with parents on issues relating to their children.
Conducted meetings and events related to the business.
Developed monthly reports and bank balance statements.
05/2005 04/2008 Assurion Salina, KS
Customer Service Supervisor
Managing and directing the daily activities of PSS agents and leads
Using all available tools to ensure effective supervising, planning, and managing functions within PSS Group
Carrying out coaching, training, disciplining, and reviewing all agents and leads
Acting as an information source and answering lead or agents questions, assigning tasks, following up and giving instructions as needed
Resolving client and internal complaints and questions
Ensuring that the team members acquire the appropriate support, tools and training to apply skills and knowledge on the job
Carrying out performance measurement and evaluation of all agents and leads to improve efficiency
Ensure consistent professional development of agents and leads
Communicating solutions, successes, best practices and opportunities within the organization
Practicing and ensuring compliance with Asurion and client policies and procedures
01/1999 - 06/2004 Making The Connections Salina, KS
Counselor
Prepared tests aimed at finding skills and abilities
Provided advice concerning their career
Discussed the available opportunities and pinpointed the advantages and disadvantages of the opening positions
Helped candidates with their interviewing skills
Communicated with various agencies in order to find out more details about the jobs available.
Kept updated with the requirements in the job market.
Joyland Dayare
Education and Training
Issuing Institution
Location
Qualification
Course of Study
Brown Mackie College
Iron Bow Technologies
KS
FL
2 Years of College or a Technical or Vocational School
Carefirst BCBS Claims 102
Information Technology for Business
Salina, KS
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