Medical Customer Service
Resume:
DENISE CAROL DUPREE
*** ********* ***** *********, ********, NC 28104
********@*****.***
OBJECTIVE:
To obtain a position where I can utilize my customer service experience and extensive healthcare knowledge, enriching the patient’s experience and guarantying their complete satisfaction.
EMPLOYMENT:
CORPORATE BENEFITS CORPORATION, INC./ TPA
Member Benefits Specialist 04/2017-10/2018
One call resolution
Senior specialist
Coordinated training material for supervisor
Incoming/outgoing calls
Responsible for benefits of over 80 plans
Gave benefits, checked claim processing, COB, EOB, OOP, checked payment/reimbursement issues, FSA, HRA, billing issues, COBRA billing, eligibility, subrogation, DME, any request asked
Emails, faxes, fax to email
Check medical necessity, coordinate covered services/pre-admissions with RN department
Contact for issues: member, provider, pharmacy, plan administrators, other insurance providers
Back up for front desk receptionist: multiple line, IVR, incoming/outgoing mail, distribution of all mail, including checks, any assigned work from managers
WESTMED
Contact Center Scheduler/Messenger 02/2016-04/2017
•Schedule appointments and procedures for a multiple location practice (over 200 physicians) including, but not limited to: Family Practice, Medical Specialties, Radiology, Physical Medicine and Rehabilitation
•Message physicians/staff
•Paging on call physicians
•Heavy interaction with patients, providers (in/outside WESTMED), and insurance companies
UHC Group- Optum
Customer Care Professional/M&R 01/2013- 02/2016
•Consult with MedicareComplete AARP individuals for :
•Advocate 4 Me Top Agent
•Billing issues (including but not limited to ICD9-10)
•PCP changes
•Plan benefits
•Payments
•RX issues
•HIPAA compliant
•Medicare compliant
• Data Release Governance
Windstream Communications
Business Sales and Service Consultant 04/2002-11/2012
•Consult with small business owners for products, services, and solutions.
•Billing inquiries.
•Order submission.
•Supervisor calls.
•Mentoring.
UnitedHealthCare
Medical Claims Administrator/employer group health policies 04/1993-04/2001
•Extensive knowledge of Indemnity, Managed indemnity, HMO, and POS plans.
•Administrated benefits in accordance with individual employer group contract specifics, state and federal mandates, the insurance company’s standard processing procedures, comply with contract exclusions, prompt pay guidelines, and applying state tax fees.
•Experienced with, but not limited to: Preventative, Well Woman, Inpatient and Outpatient facilities, Allied and Ancillaries, Surgery, Maternity, Mental Nervous/Substance Abuse, Specified Therapies (Cardiac, Chiropractic, Physical, Occupational, Speech, and Vision), Home Health Care, Skilled Nursing, Hospice, Medical Claim Review/claims needing staff nursing determinations, Pre-certification, Authorizations, In/Out of network, and Non-Compliant Health plan penalties.
•Coordination of benefits with secondary coverage.
•Determining Medicare eligibility: primary verses secondary coverage.
•Coordination of benefits with Medicare.
•Application of the current HIPPA laws.
•Investigation of Pre-existing conditions.
•Working with third party vendors/re-pricing agents.
•Adjustments.
•Prompt Pay (state mandated) penalty reimbursement.
•‘Clean Claim’ definition/penalty (state mandated).
•Correspondence.
•Designed and implemented several Operative Forms.
•Mentored trainees/Train team associates.
•Call Center back up.
•Supervisor ‘Call Back’ calls.
•Small Employer Groups.
Cigna
Medical Benefits Analyst 04/1986-04/1993
•Extensive knowledge of Indemnity, PPO, and HMO plans for large employer groups.
•Processing medical claims, mental nervous/substance abuse claims.
•Call Center back up.
•Adjustments.
Carolinas Medical Center
Emergency Department Registrar 10/1984-10/1998
•Obtain geographical, social, and employment statistics.
•Verify ER approval with proper institutions if necessary.
•Collect ER deposit, (if applicable, ER Copay or deductible) and shift reconciliations.
•Liaison with family, Police, Medic, Nurses, Doctors, Patient Advocate, and Clergy.
•Lab requisitions.
•Interpreting/inputting RN and MD chart documentation for billing
•ICD.9 codes/CPT/Revenue codes
•Knowledge of Procedures and related ‘Set-Up’/’all-inclusive’ charges
•Health Department interaction.
•Answer incoming patient inquiry calls.
TJ Maxx
Field Trainer (new store sites)/Assistant Manager 05/1977-06/1983
•Senior Trainer of 80-100 new employees on Standard Operating Procedures relating to Point Of Sale/Online Register.
•Cash Office Administration/Bank Reconciliation.
•Merchandising/Plan-O-Grams.
•Human Resource Duties.
EDUCATION
1987 Central Piedmont Community College Charlotte, NC
Sales License: Property/Casualty, Life/Health/Accident, Fire (not current at this time)
1983-1984 Central Piedmont Community College Charlotte, NC
Computer Operations, Associates Degree
4.0 GPA Operations/programming
1973–1977 Charlotte Catholic High School Charlotte, NC
College Preparatory
National Spanish Honor Society
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