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Medical Service Representative

Location:
Columbia, SC
Salary:
70000
Posted:
February 29, 2020

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Resume:

LaShonda J. Battle

843-***-****

adb16i@r.postjobfree.com

SUMMARY OF QUALIFICATIONS

** ***** ******* ******* ********

Excellent communication and organizational skills

Work in a high volume fast paced environment

Work effectively with diverse groups of people

EMPLOYMENT HISTORY

WellCare Health Plans Inc.

Operations Account Representative April 2018-current

Serves as an account lead with assigned providers maximizing the providers' ability to interact with Well Care. Manages education and issues related to claims, reimbursement, authorizations and referrals. Responsible for onsite interaction as necessary with high maintenance providers/strategic providers only.

WellCare Health Plans Inc.

Operations Account Specialist August 2015-April 2018

Coordinates and documents provider inquiries. Research and assists provider relations with resolutions of claims inquiries from Medicare and Medicaid lines of business regarding reimbursement issues, health plans payment methods, benefit coordination and eligibility or enrollment operations.

Origin Healthcare Solutions January 2014 – August 2015

Medical Billing Representative

Reviewed claim registration, worked charge edits on a daily basis, generated statements in IDX, enter anesthesia charges, post payments and work EDI rejections, and collections, print and process secondary payer claims, worker’s compensation, no fault in a timely manner. Review unbilled reports monthly and verified outstanding claims that should be billed to insurance, and respond to all correspondence from insurance carriers using Centricity software.

ENT and Allergy Associates, LLP November 2009 – January 2014

Patient Service Representative

Registered and scheduled new and establish patient’s appointments using EPM/NextGen, coordinate scheduling of surgical procedure and physician office schedule, verified patient benefits prior to procedures, collect any out of pocket expense prior to surgeries. Answered switchboard telephone, prepared charts, collected co-payments and closed out credit card machine transactions. Scanned and merged medical records with registration information into the EMR/EHR system.

Carolinas Hospital Systems September 2008 – September 2009

Medical Record Technician

Analyzed medical records by verifying doctor signatures on specific documentation, Assembled medical charts to be scanned for EMR system, merged medical records, Entered data from the medical records into the hospital database, Filed medical records in the designated area determined by the coding of the records.

Scott D. Cohen, M.D./Urologist May 2007 – July 2008

Patient Service Representative

Registered and scheduled new and existing patients appointments and procedures using Misys, Assembled and analyzed charts, Answered busy switchboard, Verified insurance, Pulled patient charts and filed medical records, Collected co-payments and old debts from patients, Called in medical orders, Ordered office supplies.

Blue Cross Blue Shield (contract position) November 2005 – April 2007

Medical Claims Processor/Collections

Processed medical claims and correspondence from medical facilities, Provided accurate benefit and general information when taken 60-75 inbound calls, Set payment plans for accounts in collection, Requested adjustments to accounts, Batched adjustments, completed audits on CPT codes, ICD-9 codes and modifiers, Verified insurance information and documentation, then filed with claims prior to reprocessing and adjusting claim.

EDUCATION

Bachelor’s Degree HS Management 2016

Associate Degree of Health Science 2014

Health Information Technology Certificate 2012

Reference Upon Request



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