Customer Service Medical

Anna Marie Mason *******@*****.***

*** *. ********* ***., **. Paul, MN. 651-***-****

My goal is to join a company whose mission and purpose align with the vision/goals I have set for myself in my personal and professional life. I strive to always challenge myself, never stop learning and above all else show kindness to everyone I encounter each day. I believe strongly in The Golden Rule and that hard work and a positive attitude are still very relevant in the ever changing workforce of today.

EDUCATION

1996 Associate of Applied Science Degree (A.A.S.) Veterinary/Pharmacology from The Medical Institute of Minnesota (currently Argosy University). Bloomington, MN. Certified Pharmacy Technician 2007-2012, Certified Veterinary Technician 1996-2012 WORK EXPERIENCE

Blue Cross Blue Shield of MN./Medix Eagan, MN. Oct.2019-Dec.2019 Appeals & Grievances Tech. Specialist (contract position) Assisted senior liaisons with claims appeals. Completed an Initial review of appeal to determine if appeal was valid, and if any required documentation and/or authorizations were provided or on file for member. Created a closeout letter to send to member If appeal wasn’t valid advising what documents/documentation were needed for appeal to accepted. If appeal was valid, created an acknowledgement letter for the member and mailed accordingly.

Researched appeals to determine if sufficient evidence to overturn claim. Research included the appeal itself and any supporting documentation of service/procedure, previous claims, members benefits and exclusions, and most importantly, BCBS medical policies and other appeal related documents. A completed case review along with case notes are sent for a final review/case determination by the senior liaison. Responsible for a timely research/review as all appeals are time sensitive due to state and federal laws. Also responsible for creating and sending all communications/outcomes to member, documentation of all case notes and letters in each case file, resolving billing issues in overturned cases, and lastly, closing/filing the appeal in accordance with BCBS document retention policies/ procedures. Aerotek/Prime Therapeutics Mendota Heights, MN. March 2018 - July 2018 Clinical Review Technician (contract position)

Processed pharmacy prior authorization requests for Medicaid members by approving/denying medications based upon benefits, medical history, diagnosis and previous rx history. Performed outreach when authorizations were incomplete.

Consistently monitored requests due to 24 hour turn-around time while maintaining high quality standards in regards to HIPAA, state and federal guidelines. Prostaff/Aterro Staffing/UCare Minneapolis, MN. April 2017-Aug. 2017 Claims Examiner (contract position)

Processed/adjudicated claims in accordance with UCare’s policies and procedures. Followed CMS Regulations and DHS guidelines to determine payment approval or denial of claims using multiple software systems and monitors.

Responsible for follow up on claims, research unresolved claims and assisting team members with projects as needed. Process denial letters when necessary.

CIOX HEALTH for Allina Health Minneapolis, MN. Aug. 2015 to Dec. 2016 EHIM/ROI/CLAIMS Specialist

Processed MVA and Work Comp (1500) claims from insurance companies requesting records and patient record requests. Responsible for redaction of any personal health information not pertinent to request. Informed supervisors of any claims that were questionable, duplicated, and/or may be fraudulent. Processed requests from clients/members for their medical records. Became very well versed in assisting members with the sometimes complicated process of the completion of the many forms required to obtain their records.

Performed audits as a third party for healthcare companies that required auditing. Strictly followed all federal, state, & HIPAA guidelines in any job duty performed. Prostaff/Aterro Staff./Rust Consulting Minneapolis, MN. Jan.-July 2013, Dec.2014-May 2015 Customer Service Specialist (contract position)

Provided scripted information to customers regarding The Independent Foreclosure Review suit. Informed customers about the status of refunds, mortgage refinance information, and general questions regarding the suit. Calls were very scripted and rules and scripts were set forth by the federal government and the OCC and all calls were monitored closely to ensure strict adherence to these policies. HealthPartners/Volt Bloomington, MN. July 2013 to Nov.2014 Customer Service Specialist (Health Promotions Dept.) (contract position) Assist members with their company’s wellness program requirements and scheduling members for Health Coach appts.

Was primary person/contact for 3M employees, responsible for 3M communications/voicemail box, researched members individual wellness programs and assisted members with completing program requirements for incentives.

Responsible for sending out 3M incentive survey emails, collecting those responses & compiling data on Excel spreadsheet to be shared with 3M.

Developed various handouts for HPD customer service team. Member Services

Assisted new mobile members with username/password resets, mobile device support, browser info. and general navigation on website.

Care Line Representative

Answered and triaged inbound calls for HealthPartner’s Careline. Based on medical information and symptoms obtained from caller, determined if call was 911 situation and would instruct the caller to disconnect and call 911, if call was urgent, call was transferred to a nurse, and all other calls, deemed non-emergency and non-urgent, were returned by a nurse in order they deemed medically necessary. MindWare Catalog Company Roseville,MN. Nov. 2011 to Dec. 2012 Customer Service/Sales Specialist (seasonal position) Provided customer service, online support help and sales in call center. Sold products to customers at a special savings when they placed an order. During the 2012 holiday season, achieved an upsell % of 44%, record was 46%.

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