Customer Service Data Entry

ANNA GRIGORYAN

*.**********@*****.*** 747-***-****

Summary

Driven candidate motivated to excel and move my career to the next level. With my extensive background and experience in the health care industry, I would love the opportunity to utilize my skillset to become a valuable asset to your organization.

PROFESSIONAL EXPERIENCE

MEDICAL

HIPPA Compliant

Research and Log Denials

Conduct and Prepare Reports

Analyze Reports and Claims

Verify Patient Eligibility

Find and Address Payer Issues

Insurance Follow-up

Data Analysis and Graphs Data

Conduct Audits

CMS-1500/UB-04 Billing

ICD-10/CPT Coding

Patient Registration

TECHNICAL/ MEDICAL SOFTWARE BACKGROUND

CRM

EPIC

CITRIX

PROD-BAY MS-4

CARECONNECT

SCPI

CMS

ICAP

CHARMAXX

Microsoft Excel, Word, PowerPoint, & Outlook

OTHER SKILLS

Bilingual in English and Armenian

Excellent Communication Skills

Highly Organized and Productive

Driven and Motivated towards Goals

Have worked with epic 6 years. I have done adjustment, refunds, reviews denial EOB’s, reviewed correspondence, appeal’s.

Prepare and processes adjustments based on review of EOB's for non-standard fee schedule and for non-payment or underpayments.

Audit posted payments; post self-payments, insurance payments, Review billing claims. Review patient accounts and update any new information for patient accounts using Epic.

Posts payments and adjustments based on EOB's received from Medicare/Medicaid

Review and interpret explanation of benefits (EOB) from insurance carriers to post appropriate payment and denial codes.

WORK EXPERIENCE

UCLA - RONALD REAGAN UCLA MEDICAL CENTER

May 2019 June 2022

COLLECTION BILLING REPRESENTATIVE

Reviewing assigned inpatient and outpatient claims

Major functions include managing a portfolio of assigned accounts

Responding to correspondence and heavy telephone contact to ensure timely follow-up

processing inpatient and outpatient claims to third party payers, following all mandated billing guidelines

process tracers, denials and related correspondence; initiate appeals; draft, compose, and submit appeal letters

St. Vincent Medical Center: Medical/ Medical Managed Care Biller:

July, 2018 – April, 2019

MEDICAL BILLER

Handled the billing and collection for Medical Full Scope/Medical Managed Care claims and analyzed, reviewed, and resolved the rejected errors.

Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.

Reviewing patient bills for accuracy and completeness, and obtaining any missing information.

Preparing, reviewing, and transmitting claims using billing software, including electronic/hard copy processing.

Following up on unpaid claims within standard billing cycle timeframe.

Checking each insurance payment for accuracy and compliance with contract discount

Calling insurance companies regarding any discrepancy in payments if necessary

Identifying and billing secondary or tertiary insurances.

Reviewing accounts for insurance of patient follow-up.

Researching and appealing denied claims.

Answering all patient or insurance telephone inquiries pertaining to assigned accounts.

Setting up patient payment plans and work collection accounts.

Updating billing software with rate changes. Updating cash spreadsheets, and running collection reports.

Analyzing UB-04 claims before sending it to Health Care Payer’s.

Sutter Physician Services: Account Representative II:

May 2014 – June 2018

Responsible for effectively managing accounts receivable of outstanding patient claims

Routinely manage and research denials and unpaid claims to resolve patient billing

Implement and adjust the Standard Operating Producers to improve the process of work flow and resolve unpaid claims and denials

Conduct, analyze and prepare reports of patient medical records to support claims and denials

Interpret correspondence from payers to analyze, appeal, or dispute the denial or claim

Implement Lean Methodology to improve the processes and minimize waste in the organization

Identify inadequate trends within the process to implement change

Provide patients with letters regarding updating their insurance benefits to process their claim

Work with various payers such as: Blue Cross, Blue Shield, Cigna, Health Net and United Healthcare

Understand and review revenue cycle to reduce workload, reducing costs, increasing net revenue while reducing defects and denials

Maximus - CA Health Care Options: Lead Customer Service Representative

October 2011 – May 2012

Answered supervisor escalation calls to resolve unsatisfied customers with questions and concerns, assisting customers in problem resolution

Assisted customers in a courteous, polite and professional manner

Operated multi-line phone system, answering excessive incoming calls for English, Armenian, and Spanish speaking customers

Assisted and processed the enrollment and disenrollment of customers in managed care plans

Accurately performed all data entry for the enrollment of healthcare application forms

Retrieved outbound calls to notify patients to enroll and choose their healthcare plans

Assisted in projects assigned by head management to improve the workflow and the quality of work

Contacted providers to notify and confirm that all medical records are accurate

Processed exception forms to the California Department of Health Care Services (DHCS)

Verizon Wireless: Telesales Representative/ Fraudulent Account Analyst

May 2009 – September 2010

Provided exceptional customer service to customers in a polite and professional manner

Answered outbound and inbound calls regarding billing questions, phone plans, and sold phones and data packages

Effectively met goals by selling phones and data packages and made sure the customers are satisfied with their service and plan

Informed customers with new updated information on their plans and answered any questions or concerns regarding their accounts

Reviewed and audited fraudulent accounts to prevent customer information and denied unauthorized accounts due to fraudulent activity and identify theft

EDS Medi-Cal: Customer Service Trainer/Command Center Expert Representative:

August 2006 – August 2008

Provided billers with patient information and verified if they have met their share of cost

Recorded details of inquiries, complaints, and comments

Assisted and explained Medi-Cal billing questions and concerns to the customer service staff

Kept records of customer interactions and transactions to ensure great customer service and that the organization remained in compliance

Assisted supervisor escalation calls to ensure the billers, customers, and providers remained satisfied

Contact this candidate