Customer Service Assistant

Qualifications Profile

Results oriented, innovative and self-motivated professional, with 25 years of verifiable success in diverse field of medical, administrative and customer service. Exemplifies solid knowledge in standard business approach. Adept at rendering efficient conflict resolution and mediation. Enthusiastic professional who is willing to accept special projects beyond job requirements. Critical thinker with keen attention to detail and time sensitivity. Consistently meets deadlines without compromising their quality and level of integrity. Expert at strategic planning and implementation. Manifests exceptional communications and interpersonal skills.

Core Competencies

oUtilization Management

oMedical Procedures

oData Entry

oFront desk and Clerical Functions

oCustomer Service

oServices Administration

oStrategic Planning

oMedical Benefits

oAdministrative Functions

oEvents Coordination

oAdmission Counseling

oTeam Leadership

oReimbursement Procedures

oMedical Terminology

Career Highlights

Efficiently coordinated the answering of large numbers of incoming phone calls; interfaced with clients and providers.

Ensured accurate compilation and documentation of mall and clerical processes.

Conducted comprehensive data entry; manually kept filing and log system on Excel.

Utilized exceptional leadership in a team setting.

Acted as a pivotal key player in addressing escalated disputes and discrepancies researches and resolutions.

Provided and offered in-services to disseminate authorization protocols into service providers.

Solely rendered eligibility, benefits and negotiated rates verification.

Input patient’s information into an automated database and ensured proper maintenance to secure accurate records.

Accumulated information on all prior authorization requests in regard to subrogation or COB applicability.

Provided utmost customer service to all internal and external clients.

Career Path

LAMPLIGHTER ONE FINANCIAL SERVICES Denton, TX 2010-Present

Loan Processor Assistant

TEXAS WOMAN’S UNIVERSITY § Denton, TX 2007-2010

Admission Assistant

CIGNA / INRTACORP § Carrolton, TX 2004-2007

Customer Service Specialist

RIVERSIDE PHYSICIAN NETWORK § Riverside, CA 2001-2004

Authorization Coordinator

MODERN HOME HEALTH § San Bernardino, CA 1998-2001

Authorization Specialist

OLSTAN HEALTH SERVICES § Corona, CA 1996-1998

Insurance Verification Specialist

AETNA HEALTH PLANE § San Bernardino, CA 1994-1996

Customer Service Specialist

Education

Bachelor of Science in Decision Information Sciences

Graduated cum laude

Medical Center of Central Georgia - School of Nursing Macon, GA

Professional Development

Managed Health Care Structure

Medicare Procedures and Guidelines

State Reimbursement Procedures

Interpersonal Communications

High-Performance Work Team Seminars

Negotiation and Conflict Resolution

Licensure

Registered Professional Nurse, Georgia Board of Nursing

Certifications

Digital University 2010

Community Reinvestment Act – Regulation BB with a score of 91%

Bank Secrecy Act for Lending Employees with a score of 85%

Identity Theft with a score of 100%

Identity Red Flag Programs with a score of 100%

Office Security – Robbery, ATM Safety and Bomb Threats with a score of 100%

Money laundering with a score of 100%

Safeguarding Customer Information-Gramm-Leach-Bliley with a score of 92%

Privacy of Consumer Financial information (Reg. P) with a Score of 93%

Office of Foreign Assets Control (OFAC) with a score of 81%

Bank Secrecy Act with a score of 100%

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