Customer Service Application Specialist

PROFESSIONAL STRENGTHS: Skilled in using a wide range of applications that aid communication, research, and database management for client; strong patient customer service skills; advanced knowledge of Excel spreadsheets; ability to handle several processes simultaneously with equal dedication to each project; skilled in learning and adapting new techniques and procedures to enhance my productivity. Experienced in working all government, commercial, and private payers across multiple states. My outgoing and receptive approach allows me to develop excellent relations with colleagues, clients, and co-workers.

TECHNICAL SKILLS: Optum Encoder, NextGen, RealMed/Availity, Navinet, Navicure, Eclinical Works, Microsoft OfficeSuite 2010, Lotus, Peachtree Accounting 3.0, Netsmart/Vision

WORK EXPERIENCE:

Lexington Health Care Chicago Ridge January 2018 to Current

Medicaid Application Specialist

I am the primary point of contact for incoming and established residents who are in need of Medicaid. My duties include working with residents to complete the Medicaid Application with the State of Illinois from beginning to end. I monitor all submissions; I follow up and gather all necessary information and attend all hearings assigned by the State.

I handle all REDE’s (yearly renewal of Medicaid) for all residents in my assigned facility.

I work with the therapy department in obtaining all benefit information for residents to complete therapy orders.

I handle all resident trust funds and banking for my assigned facility.

I conduct monthly audits of all Medicaid claims and monitor all pending Medicaid claims for residents for all facilities

I assist all residents and families with billing and payment issues.

I work with attorneys to assist in receiving Guardianship for those residents who require it.

I work with Social Workers for Discharge Planning of residents.

I run reports on outstanding amounts due from residents and work with the corporate office to collect all amounts due.

I issue all Involuntary Discharges and work with Attorneys for related State hearings.

I complete all Admission Contracts for incoming Residents.

Conifer Physician Services September 2015-January 2018

Physician Services A/R Representative IV

I work on collecting the assigned A/R for specific markets.

I handle Patient calls for billing resolution/collection.

I resolve all claim issues within the denial and no response logs, as assigned: verifying insurance, checking status of claims; obtaining all necessary information for appeals, interacting with all insurance companies for resolution; reviewing information and task practices for assistance; I code/modify claims when applicable; I handle the paper and electronic claim process

I create and present reports to management, detailing trending, or physician credentialing issues at weekly internal marketing meetings

I attend and present issues and resolutions on client calls when required

I develop and present recommendations for improved system processes to management

Parkview Orthopedic Group

Follow Up Representative/Charge Entry May 2009 – August 2015

I work all outstanding patient and insurance accounts (appeals, corrected claims, collections)

I review aging reports and resolve discrepancies

I handle Patient calls for billing resolution/collection

I post payments (Insurance and Patient)

I Charge Entry/First Pass Claim Submission

I review and prepare collection logs

Surgery Center of Joliet

Surgical Scheduler June 2006 – April 2009

I schedule all patient surgeries

I finalize OR schedule for the proceeding day

I prepare patient charts, run all eligibility checks

I process and maintain all credentialing and privilege applications/renewals for physicians

I handle Patient inquiries

I maintain database for all inventory for center

Other Positions Held

Little Company of Mary Hospital

Surgical Scheduler May 2005 – June 2006

Advanced Urology Associates

Surgical Scheduler Sept 2001 – May 2005

EDUCATION:

A.S. in Business and received an Accounting Certificate

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