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Medical Service Representative

Sheridan, WY
November 13, 2020

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David T Campbell

**** ******* **


Sheridan, WY 82801

Phone: 307-***-****



Experienced with call-center customer service communicating with members and providers Knowledgeable with the medical claims process including auditing claims data to identify and resolve errors and issues

Skilled with medical coding and billing processes including experience with ICD-9 and CPT terminology High-volume data entry of confidential information Background with medical and insurance guidelines and requirements Ability Summary

CPR and med-assist certified. Able to cook, clean, and give meds when needed. Employment History


01/2019 - 12/2019 Eagle Ridge Rehabilitative Svc 54 Seymour St, Sheridan, WY Personal care aides assist clients in everyday tasks. Home health aides and personal care aides help people with disabilities, chronic illness, or cognitive impairment by assisting in their daily living activities. They often help older adults who need assistance. Home health aides may be able to give a client medication or check the client's vital signs under the direction of a nurse or other healthcare practitioner. Duties Home health aides and personal care aides typically do the following: * Assist clients in their daily personal tasks, such as bathing or dressing * Housekeeping, such as laundry, washing dishes, and vacuuming * Help to organize a client's schedule and plan appointments * Arrange transportation to doctors' offices or other outings * Shop for groceries and prepare meals to meet a client's dietary specifications * Keep clients engaged in their social networks and communities Home health aides may provide some basic health- related services (depending on the state they work in), such as checking a client's pulse, temperature, and respiration rate. They may also help with simple prescribed exercises and or with giving medications. Occasionally, they change bandages or dressings, give massages, care for skin, or help with braces and artificial limbs. With special training, experienced home health aides also may help with medical equipment such as ventilators, which help clients breathe. Personal care aides—sometimes called caregivers or personal attendants—are generally limited to providing non- medical services, including companionship, cleaning, cooking, and driving. Direct support professionals work with people who have developmental or intellectual disabilities. They may help create a behavior plan and teach self-care skills, such as doing laundry or cooking meals. Certified home health or hospice agencies often receive payments from government programs and therefore must comply with regulations regarding aides' employment. Aides work under the direct supervision of medical professionals, usually nurses. These aides keep records of services performed and of clients' conditions and progress. They report changes in clients' conditions to supervisors or case managers, and work with therapists and other medical staff.

Customer Service Representative

07/2017 - 09/2017 Equifax Columbus, Tampa, FL

(Temp) Provided customer service related to the Equifax security breach. Assisted clients with navigation of the Equifax website and completion of online forms. High-volume data entry. Customer Service Representative

05/2017 - 07/2017 T-Mobile Benjamin, Tampa, FL

(Temp) Provided customer service for a short-term T-Mobile retention project. Resolved escalated calls and worked to retain T-Mobile clients requesting to cancel. Knowledgeable with company products and services Delivery Driver

03/2017 - 05/2017 BiteSquad Columbus, Tampa, FL

Delivered food from various restaurants to customer ? Made food deliveries in a timely manner Uber, UberEats, and Lyft Rideshare and food delivery service

Billing and Accounting Staff Assistant

10/2016 - 01/2017 CVS Benjamin Road, Tampa, FL

Billing and coding expert

High-volume data entry

08/2016 - 10/2016 Claims and Billing CSR Highland, Tampa, FL 08/2016 to 10/2016 (Contract) ? Provided member service in a high-call volume call center setting ? Submitted claims and coordinated follow-up with providers ? High-volume data entry for patient claim, medical, and insurance data ? Assisted with claims audits to identify and resolve errors and issues Claims Examiner

06/2016 - 08/2016 Cigna Highland Manor, Tampa, FL

(Contract) ? Communicated with members and providers in a high-call volume call center setting ? Managed the processing and adjudication of medical claims for Cigna members ? Reviewed claims to determine if the costs are reasonable based on the diagnosis ? Audited claims to identify and resolve errors and issues prior to adjudication Third Party Claims Examiner

06/2015 - 06/2016 First Source 8162 Woodland Center, Tampa, FL

(Contract) ? Communicated with members and providers in a high-call volume call center setting ? Adjudicated and processed claims for Aetna, Baltas Vision, and Parkland Memorial Hospital ? Assisted providers calling in to verify insurance benefits and provide detailed account information ? Indexed claims into EBIX system from scanned document

Reviewed claims to see if the costs are reasonable based on the diagnosis ? Reviewed plan documents that provide information on requirements, regulations, etc ? Authorized appropriate payment, denied claims, or referred claims to investigators for more thorough review

Education and Training

Issuing Institution Location Degree Received Course of Study Chamberlain High School Tampa, FL High School Diploma High School Diploma Altierus College Tampa, FL 1 Year of College or a Technical or Vocational School Medical Insurance

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