Data Entry Customer Service
Resume:
Sonia Rogers
813-***-**** ***********@*****.***
Summary
A professional and experienced candidate who has experience in assisting members with medical benefits and assigned members to desired network providers that Medicaid insurance in the members’ area.
Was assisting providers with authorization status and informing if benefits need authorization.
Has followed Medicaid & HIPPA regulations and supported the Provider Relations Representatives in resolving claims and payment issues.
Completed data entry of applications, reviewed for errors prior to turning in the provider files for quality review and met departmental requirements.
Processed initial and credentialing applications from providers and responded to calls from patients & referral sources.
Education
High School Diploma 1994
Chamberlain High School
Skills
Customer Service Skills, Healthcare skills (10+ years)
Motivated
Organization
Operation
Logistics
Professional Experience
Rep. Customer Care 1 August 2019
All Medical Staff-Quest Diagnostics
Handles all customer inquiries received by telephone regarding reporting of patient results, inquiries of tests and services.
Report laboratory results to clients and patients using established protocols
Document reporting or call history in required format and maintain complete and accurate records
Understands the importance of quality service and how it is measured
Perform other duties as required to meet the customer requirements
Communicates patients results via telephone, fax, or email
Customer Care Representative Apr 2018 to Oct 2018
Aerotek
Handling inbound/outbound calls to members and providers offices
Follow Medicaid and HIPPA regulations
Assisting members with medical benefits and assigned members primary care providers also looking for in network providers that Medicaid insurance in the members area
Assisting providers with authorization status and informing if benefits need authorization
Provider Operations Coordinator Oct 2017 to Feb 2018
Aerotek- Tampa, FL
Works directly with internal and external partners to collect all required information to ensure correct processing of contracts, amendments and update requests.
Works with delegated providers and IPAs to process new provider load requests along with any updates or changes within the group via a roster methodology.
Supports the Provider Relations Representatives in resolving claims and payment issues.
Performs root cause analysis of delays in provider loading and assists in bringing to resolution.
Audits configuration loads on new contracts
Credentialing Specialist May 2016 to Jan 2017
Wellcare- Tampa, FL
Responsible for coordinating all aspects of the credentialing and primary source verification process for practitioners and health delivery organizations according to policy and procedures
HIPPA training
Managed Provider applications and forms
Checked DEA, NPPES, NPDB, licensing and other regulatory websites for verification and reports
Processed initial and credentialing applications from providers, meeting departmental requirements.
Completed data entry of applications, reviewed for errors prior to turning in the provider files for quality review, meeting departmental requirements.
Medicare and Medicaid verification
Credentialing Specialist Sept 2015 to Jan 2016
Wellcare - Tampa, FL
Responsible for coordinating all aspects of the credentialing and primary source verification process for practitioners and health delivery organizations according to policy and procedures
HIPPA training
Managed Provider applications and forms
Checked DEA, NPPES, NPDB, licensing and other regulatory websites for verification and reports
Processed initial and credentialing applications from providers, meeting departmental requirements.
Completed data entry of applications, reviewed for errors prior to turning in the provider files for quality review, meeting departmental requirements.
Customer Service Rep Jan 2015 to Sept 2015
Apria Healthcare - Tampa, FL
Respond to calls from patients and referral sources
Ensure all necessary paperwork and data entry is completed accurately to facilitate efficient delivery of the order placed
Complied with all regulatory compliance areas, policies and procedures
Customer Service Rep Jul 2013 to Dec 2014
Health Plan Services - Tampa, FL
Responsible for ensuring within regulatory turnaround times.
Open to on-going coaching and development opportunities.
Meet production and quality goals
Customer Service Rep Mar 2009 to Jun 2013
Bank of America - Tampa, FL
Knowledge of Bank of America Capabilities across multiple products
Excellent ability to navigate multiple host screens and ancillary systems
Ability to interpret customer questions as part of problem resolution
Ability to understand and navigate the banks organization
Proven ability to influence business partners for proper resolution
Customer Service Rep Mar 2007 to Jan 2009
USF Physicians' Group - Tampa, FL
Accurately schedule and register patients by phone, fax, email or My Chart requests for at least 3 departments or major divisions.
Process incoming messages and able to correctly recognize and categorize and document the priority of clinical and non-clinical patient messages.
Uses clinical resources appropriately (nursing staff, supervisor, physician on call, clinical staff in the practices, etc.)
Follows protocols and policies and procedures.
Awards
Employee of the month Dec 2017
Had Employee of the month three times became a team leader in 6 months from the time a started
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