Customer Service Medical
Resume:
Peggy Johnson
*** ******* ***** *****, ***** ****8
*********@***.***
Objective
To obtain a position utilizing my education, professional skills and related work experience.
Education
•Office Automation, 1989 Graduate, Woodbridge Business Institute, Woodbridge, VA
•Medical Administration Office, September 2013 - June 2014, Pierce College, Lakewood, WA
Certifications & Training
•Customer Service Achievement Awards
•“AT YOUR SERVICE” Training sponsored by LABCORP.
•Various customer service training seminars.
Summary of Qualifications
•Strong analytical and problem-solving skills.
•Excellent leadership, supervisory, interpersonal, written and verbal communication skills.
•Effective advising and consulting skills.
•An understanding of medical terminology, anatomy and physiology.
•Work well individually and as a team in diverse environments.
•Ability to multi-task; trustworthy; organized; flexible and detail-oriented.
•Extensive experience with the following applications: Epic, Citrix,Carepricer,Passport, NextGen,EMR,Excel Spreadsheets,OneHealthPort,CHCS, AHLTA, Microsoft Office, Passport, Advance Knowledge of UB-04, ICD-10, HCPS & CPT Coding, Typing Speed 50 WPM,
AS400, Schedule Maximizer & Viewer, Medhost, IDX, HDX, Novell, and Hcapp.
Relevant Experience (Full-Time)
Inova Fairfax Hospital August 2015 - December2018
Financial Counselor III 40 Hour/Week
•Interview patient/guarantor to capture and understand key financial data to determine the patient's general financial situation and ability pay for balances due or qualify for financial assistance.
•Verified patient benefits for inpatient and outpatient procedures utilizing phone and electronic payor websites.
•Collected all deductibles, co-pays and coinsurances payments that were due per patient’s insurance company guidelines.
•Verified charges and payor codes on medical claims to ensure the valid ICD-10, CPT and HCPCS codes on rejected claims were corrected for resubmission to ensure appropriate reimbursement and compliance with all regulatory guidelines.
•Successfully calculated charges on all claims utilizing the carepricer system through NThrive.
•Responded to emails and telephone messages in a timely manner.
•Identified and implemented organizational policies, procedures and regulations to ensure total Quality Management (customer service, productivity and effective communication) throughout the hospital.
•Initiated, processed, and followed-up on patients’ appeals, referrals and authorizations in a timely manner.
•Assist with training new hire to increase the quality and production of daily expected goals.
•Successfully enforced and maintained the confidentiality of patients’ medical history, retrieved and reviewed patients’ records, and disseminated patient’s information to the appropriate offices.
•Identified, investigated, documented, and tracked patients’ billing complaints, concerns, and issues and recommended resolutions in a timely manner that resulted in minimized collection accounts and improved communication with patients.
•Successfully developed and maintained professional relationships with physicians, supervisors, nurses, and employees that led to positive and prompt resolutions of complex issues and conflicts.
•Provided patient education regarding financial approval process for services rendered.
•Ensured staff members are available to assist patients with financial aspects of services rendered.
Puyallup Tribal Health Authority
Referral Tech. Assistant 40 Hour/Week June 2014 - February 2015
•Preformed receptionist, record keeping and miscellaneous clerical duties.
•Entered, manipulated and retrieved information and data from various electronic healthcare systems.
•Used automated medical information system to schedule and maintain patient appointments with other clinics and hospitals.
• Interviewed patients for personal data and other information to complete a variety of clinical record forms complete the referral process.
•Processed referrals for patients scheduled procedures and obtained authorizations ultilizing electronic payors websites if needed in a timely manner.
•Worked closely with physicians and nurses to ensure the correct ICD-9 and CPT codes
were accurately entered on referrals to ensure proper payment.
•Initiated and followed-up on patients’ authorizations and referrals after submission.
•Verified patient eligibility and benefits utilizing phone and electronic payor websites.
•Answered phone calls from patients and providers in regards to referral requests.
•Demonstrate the components of the ICARE values statement (Integrity, Compassion, Accountability, Respect, and Excellence).
•Identified and implemented organizational policies, procedures and regulations to ensure total quality management (customer service, productivity and effective communication) throughout the organization.
Quantell
October 2010 - June 2012
General Clerk II 40 Hour/Week
•Verified patient insurance information utilizing electronic payor websites and obtained authorizations/referrals prior to scheduled visits in accordance with company guidelines.
•Responded to general questions from patients and staff regarding insurance coverage and authorizations/referrals.
• Followed up on cancelled appointments and re-scheduled as needed that resulted in on-time appointments to minimized down time and no-shows.
•Worked closely with physicians, patients and other healthcare staff to ensure the referrals/authorizations covered the needed service and that the information was obtained correctly.
•Identified and implemented organizational policies, procedures and regulations to ensure total Quality Management (cusmer service, productivity and effective communication) throughout the organization.
•Entered patient’s ICD-9 and CPT codes in the electronic AHLTA system correctly for proper billing.
•Participated in department and hospital performance improvement plan.
•Demonstrated the components of the ICARE values statement (Integrity, Compassion, Accountability, Respect, and Excellence).
•Successfully enforced and maintained the confidentiality of patients’ medical history, retrieved and prepared patients charts, and disseminated patient’s information to the appropriate offices.
•Thoroughly reviewed and updated patients’ demographic information and ordered records/x-rays/medications in CHCS and AHLTA systems as requested by providers.
•Effectively researched, analyzed, and disseminated information to physicians, supervisors, nurses, employees, and patients formally and informally via email, written, and verbal communication.
•Independently provided assistance and guidance to new employees on a variety of administrative and office procedures.
•Successfully demonstrated exceptional customer service skills, and maintained professional relationships with physicians, supervisors, patients, nurses, and co-workers that led to positive and prompt resolutions in complex issues and conflicts.
Onslow Memorial Hospital July 2008 - October 2010
Patient Access Clerk 40 Hour/Week
•Effectively collected, documented, and tracked patients’ co-pays and deductibles that resulted in minimized collection accounts.
•Verified insurance coverage utilizing electronic tools and payor websites.
•Verified charges on claims and assigned correct valid ICD-9 and CPT codes to ensure appropriate reimbursement.
•Identified and implemented organizational policies, procedures and regulations to ensure total Quality Management (customer service, productivity and effective communication) throughout the hospital.
•Successfully enforced and maintained the confidentiality of patients’ medical history, retrieved and prepared patients charts, and disseminated patient’s information to the appropriate offices.
•Independently accessed, administered, and tracked patients’ registration utilizing AS400 application system.
•Successfully coordinated and went over patient discharge paperwork to ensure a good transition from the hospital facility.
•Successfully prepared, processed, and tracked patients’ transfers and discharge paperwork utilizing the AS400 system.
•Independently communicated, scheduled, and cancelled patients’ appointments in a timely manner.
•Effectively researched, analyzed, and disseminated information to physicians, nurses, and patients formally and informally via email, written, and verbal communication.
•Independently provided assistance and guidance to new employees on a variety of administrative and office procedures.
•Successfully developed and maintained professional relationships with physicians, supervisors, nurses, and co-workers that led to positive and prompt resolutions in complex issues and conflicts.
•Identified, investigated, and analyzed organizational departmental issues; evaluated and examined patient complaints; and recommended solutions that minimized further complaints, limited organizational legalities, and improved communication with patients.
•Provided administrative assistance and guidance to patients with completion of Tricare questionnaires, and other healthcare forms.
Inova Fairfax Hospital March 2002 - August 2006
Financial Counselor III 40 Hour/Week
•Interviewed patient/guarantor to capture and understand key financial data to determine the patient's general financial situation and ability to pay for balances due or qualify for financial assistance.
•Collected patient’s deductibles, co-pays and coinsurances payments according to their insurance company benefits and guidelines.
•Verified patient benefits for inpatient and outpatient procedures utilizing phone and electronic payor websites.
•Contacted patients over the phone and in person to collect, Co-pays, Deductibles and Co-insurance, and also explained their insurance benefits.
•Verified charges and assigned valid ICD-9, CPT and HCPCS codes on rejected claims to ensure appropriate reimbursement and compliance with all regulatory guidelines.
•Identified and implemented organizational policies, procedures and regulations to ensure total Quality Management (customer service, productivity and effective communication) throughout the hospital.
•Successfully enforced and maintained the confidentiality of patients’ medical history, retrieved and reviewed patients’ records, and disseminated patient’s information to the appropriate offices.
•Identified, investigated, documented, and tracked patients’ billing complaints, concerns and issues, and recommended resolutions in a timely manner that resulted in minimized further complaints and improved communication with patients.
•Administered, disseminated, maintained, and tracked patients’ demographics and insurance information.
•Successfully developed and maintained professional relationships with physicians, supervisors, nurses, and co-workers that led to positive and prompt resolutions in complex issues and conflicts.
•Coordinated, processed, tracked and followed-up on patients’ referrals and authorizations submitted by physicians in a timely manner.
•Thoroughly reviewed and posted patients’ cash and credit card payments utilizing the accounting system.
Contact this candidate