Care Specialist Childcare Provider
Resume:
Annie Gainey
Customer Care Specialist
Newport News, VA
************@*****.***
Handle large call volume
Inbound and Outbound call experience
Effective communication
Provide excellent customer care
9 years experience with customer care
Authorized to work in the US for any employer
Work Experience
Claims Processor
WPS Health Solutions - Hampton, VA
August 2018 to March 2020
Claims Processor
Process all Military and Veterans Health (MVH) claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), eligibility, and claims development.
Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations.
Calculate multiple Other Health Insurance (OHI) COB amounts using data from claims, such as the EOB or prior payment information given. Identify when to spend time with other departments based on guidelines.
Process all claim types by determining corrective action to be taken on various types of errors pended by system and resolving interactive edits.
Adjudicate specialty claims, including, but not limited to ambulatory surgery, skilled nursing, dental, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional based charges.
Obtain and analyze claims data to determine specific problem areas including external communication to obtain data.
Communicate with the inquirer to determine appropriate authorization or referral of services.
Submit claims for adjudication, correction, payment, or review as appropriate.
Educate providers on billing requirements of TRICARE to reduce claim problems.
Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.
Respond to inquiries using various forms of communication (written letter, telephone, web, or email) within time frames to exceed contractual standards.
Collect and record data for Customer Service records and computer analysis.
Inform supervisory staff of system problems when identified, researching problems to provide backup data and examples when needed.
Answer inquiries concerning explanation of benefits (EOB)
August 2017 -. September 2018
Customer Care Specialist
Process all Military and Veterans Health (MVH) claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), eligibility, and claims development.
Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations.
Calculate multiple Other Health Insurance (OHI) COB amounts using data from claims, such as the EOB or prior payment information given. Identify when to spend time with other departments based on guidelines.
Process all claim types by determining corrective action to be taken on various types of errors pended by system and resolving interactive edits.
Adjudicate specialty claims, including, but not limited to ambulatory surgery, skilled nursing, dental, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional based charges.
CSR - Customer Service Representative
Randstad - Virginia Beach, VA
May 2016 to June 2017
High call volume with inbound calls and managed care plans help members decide what plan is best for them to suit their needs, offer great customer care, enroll members into health plans, make members aware of renewals and benefits of plans. Educate patient concerning Medicaid guidelines .
Childcare Provider
Self employed - Hampton, VA
December 2014 to March 2017
Provide personal care for 2 children, feed, bath monitor etc.
Account Representative/Customer Service
Portfolio Recovery Associates - Hampton, VA
May 2012 to October 2014
Responsibilities
Handle large call volume inbound and outbound calls.
Assist customers with choosing the best payment options to resolve delinquent accounts.
Accomplishments
I provided excellent customer service and problem solving.
Skills Used
Great communication skills in which listening is the major part of.
Nurses Aide
Solutions Staffing & Home Health - Hampton, VA
March 2010 to September 2014
Responsibilities
Assist clients with daily living and distribution of medication which is documented daily along with progress and all activities of client aide the client with physical and mental disabilities to make their lives as normal as possible.
Accomplishments
Clients become like family members just because they are aged or disable does not mean that they don't deserve the best care and respect.
Skills Used
Compassion
Education
High school or equivalent in Nursing
Norfolk Vocational Center - Norfolk, VA
Skills
Do you have any of these top skills employers are looking for?
EMR Systems
Insurance Verification
Medical Coding
Laboratory Experience
ICD-10
Employee Orientation
Accounting
Hospital Experience
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I have ten years of Healthcare experience and 9 years of customer service experience. 2 years claims processing,3 years loan originator
Call Center
Customer Care
Customer Service
Customer Support
Medicaid
Claims Processing
Managed Care
Data Entry
Cold Calling
Medical Billing
Medical Records
Microsoft Excel
SharePoint
Microsoft Word
Microsoft Outlook
Microsoft Office
Windows
10 key calculator
Medical terminology
HIPAA
Medicare
Analysis skills
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