Service Representative Customer
Resume:
DIANA ALDRETE
GLENDALE, AZ 85306
*********@*****.***
SUMMARY
Seasoned Lead Customer Service Representative with extensive knowledge in both provider and patient relations in the medical insurance industry. Assumed supervisory duties when necessary for escalated calls and assisted representatives as needed.
EXPERIENCE
Provider Support Customer Service Representative
Blue Cross Blue Shield of Arizona Phoenix, AZ Dec 1998-June 2018
Provided outstanding customer service emphasizing in excellence, privacy, compliance, and versatility within the health insurance industry
Researched, identified, processed, responded, and resolved provider and customer inquiries via inbound/outbound calls
Supplied information to providers and customers regarding BC/BS AZ programs, services, contract benefits, changes in coverage, eligibility, etc.
Managed and worked claim edits, pre-certifications and authorizations, researching and processing adjustments
Consulted, calibrated, and coordinated with various internal departments, external plans, providers, businesses, and government agencies to ensure resolution of customer and provider inquiries
Document and maintain working knowledge of the required BC/BS systems, procedures, forms, and manuals
Worked with providers to ensure member insurance coverage for pre-certifications/authorizations
Maintained regular and reliable attendance
Communicated in English language with providers and members, one on one and by phone
Maintained confidentiality and privacy per HIPAA laws
Navigate and gather input and maintain data records in multiple system applications
Patient Account Representative
Phoenix Baptist Hospital and Medical Center Phoenix, AZ Oct 1987-Dec 1998
Gained extensive knowledge of billing, able to explain in detail statements to subscribers, coder/researcher for further understanding
Onsite training with providers regarding billing issues, and coverage explanations per policies for HMO and PPO discounts
Promoted to Patient Account Representative, duties included but not limited to; resolving customer complaints related to patient’s hospital charges and procedures,
Maintained current knowledge of Federal and State billing and collection laws and regulations
Worked with insurance companies on contractual payments due to the hospital
Completed adjustments for contracted insurance companies for subscribers and providers
Applied all payments once patient research and investigation was competed
Conducted training for providers on correct medical billing
Credit Card Collector
Banc One Phoenix, AZ Jun 1995-Dec 1998
Anesthesia In-house Referral Coordinator
CIGNA Health Plan Phoenix, AZ Aug 1986-Sep 1987
Physicians Biller/Collector (worked evenings)
St. Joseph's Hospital Phoenix, AZ Jun 1987- Mar 1988
Customer Service Representative Oct 1983 – Mar 1986
AT&T
Supervisor Final Accounts
Mountain Bell Apr 1981- Oct 1983
ADVANCED SKILLS
Possess vast knowledge of:
Medical Insurance billing procedures
ICD9 and CPT coding
Medical Record Research
Strong Customer service and relations experience Experienced teleworker
Call Center experience
Trained and Audited new Representatives when they reach the floor
Excellent communication and interpersonal skills
Ability to handle numerous, complex tasks simultaneously
Work well under pressure with ability to adapt quickly
Bilingual-Spanish
Utilization Management/FEP policies and procedures
EDUCATION AND TRAINING
High School Diploma
Carl Hayden High School Phoenix, AZ
REFERENCES
Professional
Lisa Bonsignore
Office Manager
Dr James Miller, DMD
9821 N 95th Street
Scottsdale AZ 85258
Office 480-***-****
Cell 602-***-****
Known 7 years
Sendia Campos
Lead Customer Service Representatives
9151 W Pierce Street
Tolleson AZ 85353
Office 602-***-****
Cell 602- 376-1247
Known 10 years
Personal
Esther Rivera
Wells Fargo Phoenix, AZ
Office 602-***-****
Cell 602-***-****
Known Lifetime
Olivia Galindo
1602 S. 124th Ave
Avondale, AZ
Cell 602-***-****
Contact this candidate