Claims Examiner Customer Service
Resume:
**** **** ****** **, **********, AL ***** 205-***-**** ***********@*****.***
Omeika P. Crenshaw
Objective
To obtain a professional career with a dynamic organization that welcomes motivation, leadership, initiative, dedication, and experience.
Skills
Customer Service
Medical Terminology
Problem Solving
Auditing
Medical coding
Flexibility
Researching
Management
Teamwork
Accounts Receivable
Insurance Precertification
Self-Starter
Accounts Payable
Verifying Insurance Benefits
Multitasking
Data Entry
Communication
Microsoft Office
Experience
01/2010 - present
Crenshaw’s Lawn and Shrub Care
Birmingham, AL
Office Manager
Oversee and support all administrative duties in the office and ensure that the office is operating smoothly.
Manage office supplies inventory and place orders as necessary.
Perform receptionist duties: greet visitors, answer and direct phone calls, liaison between office and field employees.
Receive and sort incoming mail and deliveries and manage outgoing mail.
Develop office policies and procedures, and ensure they are implemented appropriately.
Assist with office layout planning and office moves, and with managing and maintaining IT infrastructure.
Submit proposals for jobs.
Performed all accounts payables to vendors and suppliers, and accounts receivables to all customers and contractors.
Make daily Bank Deposits
Process timesheets and payroll.
Manage office budget.
Identify opportunities for process and office management improvements, and design and implement new systems.
Provide other administrative support as necessary, including scheduling group meetings, maintaining calendars, doing research, and creating reports.
02/2008 – 04/2010
Children’s Hospital
Birmingham, AL
Access Facilitator /Scheduler
Scheduled patient appointments for various clinics, tests, radiology x-rays and scans, procedures, and surgeries.
Verified patient insurance coverage and benefits, obtained precertification and authorizations for various procedures, tests, certain radiology x-rays and scans, and medical procedures and surgeries.
Made daily deposits. Balanced credit card machines and other deposit reconciliations as required.
Pre-registered patients. Demonstrated ability to have meaningful discussion of benefits with patients when pre-registering, and when present in the department.
Discharged patients from clinics and entered various charges and provided medical terminology to enter patient diagnosis.
Provided financial counseling. Communicated with patients to establish payment expectations based on individual insurance benefit plans.
Demonstrated skill with EHR or EMR system as required.
Provided timely and accurate information regarding patient data and status to other health system departments, physicians, physician office staff, and other public agencies while ensuring patient confidentiality is not breached.
Exhibit excellent customer service skills and serves as an advocate for the patients in obtaining and understanding all financial assistance programs.
05/2004 – 10/2007
HealthSouth Corporation
Birmingham, AL
Accounts Receivable Representative Supervisor
Managed 30 employees, reviewed and processed time and attendance for payroll, provided disciplinary reinforcements, performed employee review appraisals, interviewed potential candidates, trained new employees, generated, and balanced annual/end of month/quarterly reviews/reports, was the liaison between multiple facilities.
Researched complex claims and account issues, documented and reviewed documentation and account issues, provided medical coding, interpreted medical terminology and appropriate billing per the explanation of benefits, and posted medical insurance and patient payments and refunded patient/insurance companies’ payments and credits, applied the proper contractual discounts.
Reviewed accounts to assure timely filing.
Reviewed accounts for payments and balances.
01/2000 – 12/2001 United Healthcare Birmingham, AL
Customer Service / Claims Examiner
Trained new employees, provided quality assurance for training purposes.
Assisted members/providers/plan administrators with inbound calls regarding eligibility, benefits coverage, and claims processing.
Researched complex claims issues, reviewed, processed, and adjusted claims for payment.
02/1998 – 12/1999 GuideStar Health Systems Birmingham, AL
Birmingham, AL
Customer Service / Claims Examiner Leader
Reviewed and processed time and attendance for payroll, provided disciplinary reinforcements, provided quality assurance for training purposes, and interviewed potential candidates.
Trained new employees, assisted members/providers/plan administrators with inbound calls regarding eligibility, benefits coverage, and claims processing.
Researched complex claims issues, reviewed, processed, and adjusted claims for payment.
10/1997 – 05/2000
Faulkner University
Montgomery, AL
Bachelor’s in business administration
Minor in Criminal Justice
Currently pursuing master’s degree in Special Education
References
References are available on request.
Contact this candidate