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Claims Specialist, Claims Supervisor, Data Entry Specialist

Location:
Riverdale, GA
Posted:
July 22, 2022

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Resume:

KARIN ELLIS

*** ******* *** **, *********, GA ***74 Phone: 404-***-****

adrt73@r.postjobfree.com

EXECUTIVE PROFILE

Motivated and dependable professional with years of expertise in fast-paced environment utilizing excellent Client Relations and Service Satisfaction. Proficient in job execution and proven track record of success in compliance, customer service and leadership.

STRATEGIC AND CREATIVE THINKER with solid background in delivering decisive, action-driven leadership. Demonstrates expert insight and proficiency in teaching, coordinating, monitoring, evaluating and communicating clients.

RESULTS-ORIENTED PROFESSIONAL with proven capacity to manage and coordinate operations and administrative support, using initiative, resourcefulness and good judgement.

PERFORMANCE-DRIVEN TEAM PLAYER with excellent interpersonal skills and attention to detail, optimally utilizing all channels of communication to assist operations. CORE COMPETENCIES

Microsoft Office Result Execution

Deadline Oriented

Administrative

Communications Skills

Time Management

Training & Development

Subject Matter Expert

Problem Solving

Team Management

Process Improvement

Quality Assurance

Leadership

Conflict Resolution

Customer Service

Reports/Documentation

Claims Management

Quality Control

PROFESSIONAL EXPERIENCE

SOUTHEAST TRANS INC 08/2019-CURRENT

JOB TITLE: CLAIMS SUPERVISOR ATLANTA, GA

• Supervise, develop and coach new Claims Representatives in order to resolve claims accurately.

• Ensure and enforce strict company standards and monitor team performance.

• Conduct performance evaluations, providing constructive feedback as needed in order to enhance overall efficiencies.

• Provide recommendations towards process improvement in support of quality, workflow, policies and procedures.

• Maintain a high level of integrity and professionalism in achieving individual and organizational goals.

• Assist in resolving issues related to claims, ensuring staff met/exceeded all key performance metrics.

• Monitor timekeeping in support of accurate payroll processing. JOB TITLE: INTERIM CLAIMS TRAINER DATE

• Provided on-the-job training to new hires and served as subject matter expert to current staff.

• Served as coach/mentor, demonstrating thorough knowledge of claims process.

• Managed assigned accounts from inception to completion.

• Facilitated meetings for professional development and updates in organizational process. JOB TITLE: ACCOUNT REPRESENTATIVE DATE

• Resolves and reconciles incoming phone inquiries efficiently and courteously in timely manner or create a backlog to be researched

• Provides secondary customer service to primary clients' patients in attempt to remediate account issues, reports contact disputes to client in order to have accounts resolved within timely limits

• Reviews contracts between client and insurance to insure facility is reimbursed per contracted rate

• Prepare and submits unbilled claims, corrected claims, claim reconsiderations, and provider appeals

• Maintains strictest confidentiality; adhere to all HIPPA guidelines/regulations

• Collects and follow up on all accounts assigned prior to, during, or after admission and discharge, communicates financial policies to all patients

• Verifies, researches, and completes all paperwork to billed Medicare and Medicaid claims for reimbursement JOB TITLE: SWITCHBOARD OPERATOR 11/2007-CURRENT

• Promptly and professionally answers incoming calls and electronic communication, greeting callers, providing information, transferring calls

• Offering transfer or redirection of calls as needed for return calls, routes urgent calls appropriately

• Assist callers in locating the correct department by access Work Tracking System to view policy information

• Answers multi-line telephone; greets visitors; takes messages; handles incoming and outgoing FedEx and UPS packages; handles incoming and outgoing mail; operates various office machines including copier, scanner, postage meter, fax machine and laminator

• Responds to medical records requests timely, uploads documents into electronic health records for quality assurance

• Provides computer back-up, resulting in minimal downtime, troubleshoot and oversee and secure computer connections

• Investigates and responds to questions and provide necessary information in a prompt manner

• Oversee all emergency calls are paged promptly with no delays. JOB TITLE: CCC SERVICE REPRESENTATIVE (SEASONAL) 11/2007-CURRENT

• Provided first contact technical support for internet customers and business partners via the telephone and email

• Used knowledge base and documentation systems to troubleshoot, resolve, document, and/or research incidents

• Followed and supported workforce management, service management, and incident handling procedures and philosophy to resolve business partner's problems

• Responsible for diagnosing and documenting customer's technical and "How To" problems and resolving, escalating or assigning problems to appropriate area

• Identified, resolved, escalated or assigns routine incidents with minimal supervision

• Demonstrated thorough understanding of incident handling environment within the enterprise

• Created and recommended solutions to be published in the knowledge-based system

• Learned and applied continuous process improvement skills and techniques

• Demonstrated knowledge of other State Farm departments, structure, and processes

• Understand and supported the vision and strategy of the department to meet the objectives of the company RECONCILIATION SPECIALIST 10/2011-

• Develops an unwavering commitment to execute tasks within a timely manner, maintained group cooperation and support with team members

• Resolves complex issues, identifies problems and develops solutions for all areas in connection with reconciliation reports

• Analyzes and balances daily transactions for foreign currency and weekly teller reconciliation reports for multiple markets, using Microsoft Office

• Effectively manages numerous client inquiries and ensure that requests are completed in an effective and timely manner

• Creates and supports required database solutions for automations by developing business specifications and liaising with developers in refining them

• Enables department to meet annual automation goals by establishing departmental / management consensus for automation methods and strategies as well as development of infrastructure for metric reporting and user requests

• Daily working of membership data discrepancies between the Health Care Exchange and client and the Carriers

• Comprehensive knowledge and understanding of working within Federal and State regulations to ensure that business processes adhere to them

• Evaluates and ensures overall business processes are aligned and being performed within company policy and procedures CUSTOMER SERVICE REP 11/200*-**-****

• Ensured accurate data entry and completion of authorization from referral/authorization forms, medical documentation, contacted providers to obtain missing medical documentation to assure compliance with timelines

• Completed registration process for new patients including verification of insurance coverage

• Checked patients in for appointment with providers, collected co-pays and directed patients to the correct waiting area

• Answered questions for patients, physicians and medical staff regarding medical records via telephone and in person in a polite, detailed manner following HIPPA regulations

• Welcomed patients, assisted them with paperwork, and answered questions about insurance, appointments and medical services

• Responsible for calling insurance companies and obtaining pre-authorizations for diagnostic tests and admission as required by insurance companies

• Led trainer of new employees, and assisted with the newly established Tennessee site OTHER POSITIONS HELD:

DISPATCH REPRESENTATIVE 11/2007-10/2009

EDUCATION

UNIVERSITY OF PHOENIX PSYCHOLOGY 2013-CURRENT

FOREST PARK HIGH SCHOOL HIGH SCHOOL DIPLOMA 2006



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