Service Representative Medical Billing

CHAD B. GOODMAN

CUSTOMER SERVICE REPRESENTATIVE/INSURANCE VERIFICATION SPECIALIST/LEAVE OF ABSENCE COORDINATOR WITH 10+ YEARS OF EXPERIENCE INCLUDING RETAIL, CALL CENTER, AND INSURANCE/BENEFITS ENVIRONMENTS.

Professional Summary

Over 3 years medical billing and medical claims processing

Over 10 years customer service and high debt collections, including but not limited to credit, medical, accounts payable/receivable, payment arrangements

Highly skilled in gathering, compiling, and maintaining credit information including bankruptcy, skip tracing, and charge offs

Self-motivated with the ability to interface well with internal and external customers

Proven record of contacting customers about delinquent payments and preparing reports reflecting class of credit and collection activity

Worked over 10+ years of processing Medicare/Medicaid

Self- motivated and self-starter in various projects, utilizing both internal and external communication Skills

Overview

Experience with medical claims

Medical accounts receivable

Worked with hospitals and private physicians

Medical Billing

Medicare/Medicaid

Education:

Northside Highschool of Medical Professions

1989 to 1992

Southwest Highschool 1993

Advanced Honours Diploma

Professional Work Experience:

Pharmacy Technician

CSR Anthem

12/2014 – 08/2019

Inbound calls for pharmacy and medical prior authorizations

resolving pending

Extensive Call center experience/ Experience on the phone/ Customer service experience

Medical Terminology

Responsible for achieving high recoveries against a portfolio of claims.

Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy and disputes.

Issues while providing excellent customer service.

Customer Service Representative

Patient Care Advocate

Subject Matter

Expert with Express Scripts A Leading Nationwide Pharmaceutical Provider

July 2010 - August 2014

Responsibilities include answering incoming calls from members, determining the nature and resolution of member issues and questions, responding to, researching and resolving member inquiries using proprietary databases, online job aids, reference materials and other available resources, documenting inquiries, issues, status and resolution in accordance with department /company policies and guidelines, managing customer disputes and issues in a private manner; conveying a positive image on the telephone, achieving specific call targets to include quality, average handle time and overall customer satisfaction.

Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services including, but not limited to, major medical insurance benefits (including Medicare), complex insurance plans, and high volume PBM plans.

Understanding the authorization process and working with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical, and PBM.

Responsible for recovering payments from commercial insurance carriers who should have paid primary to the Medicaid agency.

Billed HCS and TXHML individuals into CARE

Handled invoices for contracted facilities and in home dayhab

Worked in Accounts Payable to bill and claim adaptive aids

Modern home modifications and Dental Invoices.

Working knowledge of CPT, HCPCS, and CMS-1500

Strong understanding of third-party billing and/or claims processing.

Claims Recovery Specialist

Experience with third party institutional billing

Requirements include participation in and successful completion of on-going training, appropriate responses to test calls, client inquires and/or testing exercises, as well as adhering to department and company policies and standard operating procedures, performing other special projects, related duties and other responsibilities as assigned

Awarded numerous bonuses for quality work and exceeding expectations.

Customer Service Representative

Insurance Department of Columbia

July 1998 to March 2010.

HCA Patient Account Services, the central billing, collection and liason office representing over 100 company owned hospitals.

Responsibilities included analyzing patient service accounts to determine payments due and responsibilities for debt, billing and collection of insurance payments from both private/commercial and government insurers, sending correspondences to effect collections and resolve issues, resolving individual/personal amounts due and arranging payment schedules per company guidelines and resolving disputes over debt responsibilities.

Required accurate communication of problems, typing and computer skills, comprehensive teamwork efforts by training numerous new employees and resolving related account problems.

Selected “Employee of the Month” top department collector for several months and awarded numerous bonuses for collections and customer service achievements.

Workers Compensation Insurance Claims Processor

Houston General Insurance Company thru TRC Staffing Services.

November 1997 to June 1998.

Responsibilities included analysis of insurance claims, obtaining medical data, resolution of problem areas and recommending insurance payments and adjustments.

Customer Service Representative

Kroger Grocery Store

1995 to 1997.

Responsibilities included assisting customers, operating cash register, processing financial transactions, and arranging product

displays. Demanded attention to detail and continued problem solving.

Nurse Technician

Harris Methodist Hospital Southwest.

1993 to 1994.

Responsibilities included filing medical records, data entry of patient information, sterilizing surgical equipment

Answered patient questions regarding financial resolution

Resolved financial responsibilities with payment plan terms

Checked in patients for office visits, and scheduled appointments

Contacted patients that were delinquent in payment by mail, email, or telephone

Performed patient billing and reporting activities in a timely fashion

Teamwork was mandatory.

Contact this candidate