Scheduling Coordinator Customer Service

HEATHER MORRILL

** ***** ***** *****, ** ***** 732-***-**** ************@*****.*** https://www.linkedin.com/in/heather-morrill-4560b922b/

SKILLS

●Workers' compensation claims and subrogation knowledge

●Excellent customer service skills proven through internal and external customer interactions

●HIPAA Compliance knowledge

●Claim investigation, audit, and Fraud identification

●Medical, dental, and insurance terminology

●New Jersey State Dental Radiological License

●Conflict and claims resolution

●Policy knowledge and benefit explanation

●Suburb soft skills in high pressure fast paced environment

EXPERIENCE

3/2017 to 11/2021 Third Party Liability Specialist

Horizon Blue Cross Blue Shield of New Jersey

Wall Township, NJ

●Investigated and responded to work accident leads from Horizon Appeals, Legal department, customer service, members, and other insurance carriers

●Reviewed first level appeals from members and providers regarding denied claims related to Workers Compensation claims

●Maintained effective diary system and document all activities in accordance with current procedures

●Worked with multiple Workers Compensation carriers to determine responsibility and create settlement authorities for cases

●Investigated and obtained detailed information regarding the facts and circumstances of the injuries to determine cause of accident.

●Effectively monitored and tracked ongoing workers compensation cases and assisted legal by providing documents for court cases

●Monitored reimbursement notices received for Subrogation Third Party Liability cases

●Loaded Workers Compensation Coordination of Benefit files in claims system to prevent future claims from processing in error and audited reimbursement reports submitted by vendors

●Recapped members claims that were deemed to be Workers Compensation related

●Assisted in negotiation reimbursement dollars with Legal, ensuring laws and group contracts are appropriately applied

●Supported senior leadership by reporting weekly and monthly recoveries to share point database for accurate recording

●Collaborated with internal and external parties to ensure timely resolution to cases

06/2008 to 03/2017 Dedicated Member Services Represented for NJ Transit

Horizon Blue Cross Blue Shield of New Jersey

Wall Township, NJ Dedicated Member Services Representative for NJ Transit and PG Groups

●Dedicated member services representative for NJ Transit and other dedicated PG groups

●Handled high volume of calls while maintained first call resolution

●Processed FELA claims for NJ Transit Workers Compensation claims

●Assisted Manager with resolving escalated issues they would receive from dedicated groups and from complaints and appeals

●Worked in conjunction with Benefit Administrators from NJ Transit and PG groups to assist and resolve escalated issues with claims and benefits

●Exceeded the Horizons standards in both Quality, Production and First Call resolution

●Knowledge of Indemnity, PPO, HMO, POS, DA and other managed health care plans

06/2006 to 06/2008 Scheduling Coordinator Joseph Feldman D.D.S. & Associates

Manasquan, NJ

●Managed Doctors, Hygienists and patients schedules

●Answered phones and scheduled patients appointments

●In charge of shipping and receiving lab cases

●Processed and mounted x-rays

●Maintained and filed patients charts

●Confirmed patients daily appointments with follow up phone calls

●Maintained reports of patients incomplete treatments

●Assisted patients with treatment plans and insurance information

●Processed insurance claims and took payments from patients

EDUCATION AND TRAINING

06/2006 Dental Assisting

Ocean County Vocational-Technical School

Toms River, NJ

06/1996 Medical Assisting

Lincoln Technical Institute - Edison

Islin, NJ

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