Operations Coordinator Claims Representative

NNEKA CLASH

*** ******* *****, ** ***** Cell:443-***-****

***********@*****.***

Qualified Customer Services Representative with 10 or more years in fast-paced customer service and call center environments. Personable and professional under pressure.

EXPERIENCE

PROJECT SUPPORT/OPERATIONS COORDINATOR, 03/2018 TO 11/2020

QLARANT- EASTON, MARYLAND/ DALLAS, TEXAS

OPERATIONS COORDINATOR CONDUCTING MEETING AND TAKING MINUTES FOR CMS, PALMETTO, CGS AND NOVITAS. SENDING DAILY AND WEEKLY REPORTS TO THE MAC’S. PLAYING A SUPPORTIVE ROLE TO ADMINISTRATION AND INVESTIGATORS TO ENSURE THAT INFORMATION IS HANDLED PROPERLY

CUSTOMER SERVICE REPRESENTATIVE, 01/2017 TO 03/2018

NOVACARE REHABILITATION – CLARKSVILLE, MARYLAND, UNITED STATES

SCHEDULE APPOINTMENTS FOR EXISTING AND NEW PATIENTS FOR BOTH PHYSICAL AND OCCUPATIONAL THERAPY. VERIFY PATIENT INSURANCE COVERAGE. OBTAIN PRIOR AUTHORIZATIONS FOR SERVICES WHEN NEEDED. COMPLETING DAILY CHARGES FOR THE PREVIOUS DAY. MAKING SURE THE THERAPIST ARE UPDATED ON THE INFORMATION NEEDED TO SUCCESSFULLY TREAT THE PATIENTS. VERIFY THAT WE HAVE ALL PLANS OF CARE SIGNED BY PHYSICIANS FOR OUR MEDICARE PATIENTS AND THAT WE HAVE UPDATED AUTHORIZATIONS ON FILE TO CONTINUE TREATMENT.

CLAIMS REPRESENTATIVE, 12/2010 TO 07/2016

APWU HEALTH PLAN – GLEN BURNIE, MARYLAND, UNITED STATES

ICD-10 AND CPT CODING REVIEW FOR BILLING AND PROCESSING ACCURACY. CLAIM REVIEW FOR BENEFITS AND ADJUDICATION EXPLANATIONS FOR HEALTH PLAN MEMBERS AND PROVIDERS. INITIATION OF RESOLUTION PROCESS OF CLAIMS, ENROLLMENT, AND PROVIDER FILE CORRECTIONS AND ADJUSTMENTS. ASSISTED MEMBERS IN RESOLUTION OF BILLING CONCERNS AND COORDINATION WITH PROVIDERS OF SERVICES. FACILITATED RESOLUTION OF NETWORK PRICING DISCREPANCIES AND INQUIRES.

CUSTOMER SERVICE REPRESENTATIVE, 08/2010 TO 12/2010

MEDIX – ROCKVILLE, MARYLAND, UNITED STATES

CUSTOMER SERVICES REPRESENTATIVE TASK. GAVE INSURANCE BENEFITS TO HEALTH CARE MEMBERS AND PROVIDERS. TEMPORARY POTIONS WITH AMERICAN POSTAL WORKERS UNION HEALTH PLAN (APWU) FOR THREE (3) MONTHS UNTIL BEING HIRED PERMANENTLY.

EDUCATION

HIGH SCHOOL DIPLOMA: 1991

CAMBRIDGE SOUTH DORCHESTER HIGH SCHOOL - CAMBRIDGE, MARYLAND

BBA: HEALTH CARE, TOOK TIME OFF.

STRAYER UNIVERSITY - ONLINE

SKILLS

Creative problem solver

Exceptional communication skills

MS Windows proficient

Quick learner

Strong client relations

Medical terminology knowledge

Reliable

Team Player

Hard worker

Exceptional attendance

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