Sales Associate Customer Service

Marcine Morgan

786-***-****(c)

**********@*****.***

Miramar, Florida

OBJECTIVE: To obtain a position allowing me to further develop my skills, experience and knowledge EMPLOYMENT

Integrated Home Care Miramar, FL

Claims Examiner, 06/2019-Present

• Review Medicare/Medicaid/DME/HH/Infusion fee schedules and resolves claim by approving Or denying them base on documentation.

• Work on adjustment by reviewing the claim and resolving the issue.

• Work on special projects and tasks as assigned by manager with other duties. Team Health Sunrise, FL

Allowable Representative, 01/2019-06/2019

• Review all over and under allowed claims that were not paid appropriately.

• Review/work of weekly variances reports for both over and under allowed invoices in order To monitor changes in contracted reimbursement.

• Review /work of monthly aging.

• Review documentation, including remittances and claims.

• Internet research for fee verification and product line information, participation status, telephone calls To carriers, etc.

• Review contract verbiage.

• Run standardized reports and queries.

• Invoice adjustments as necessary as directed by management.

• Obtains updated fee schedules.

• Communicate openly with other departments within the Billing Center, Corporate and Affiliates in • Order to have identified issues resolved to eliminate variances.

• Collections on under allowed variances.

Borinquen HealthCare Center Inc., Miami, FL

AR Insurance Verification Clerk, 06/2014-12/2018

• Verify insurance eligibility via insurance websites or by calling insurance companies, updating patient Insurances, and prepare Accounts for a “clean” claim submission within a timely manner.

• Process daily insurance verification requests received by reviewing the eligibility bucket in Athena worklist dash board.

• Work to resolve billing issues by reviewing and researching insurance denial codes and/or rejection messages. Perform special projects and other duties as assigned by supervisor or manager within given deadlines.

• Research insurances and keeping up-to-date with insurance requirements and billing guidelines Also request authorization for patient procedure, OB/Care, ultrasound, surgery. Caledonia Financial Services, Plantation, FL

AR Insurance Verification Clerk, 04/2010-05/2014

• Verify insurance eligibility via insurance websites or by calling insurance companies, updating patient insurances, and prepare Accounts for a “clean” claim submission within a timely manner.

• Process daily insurance verification requests received by accounts receivable representative.

• Work to resolve billing issues by reviewing and researching insurance denial codes and/or rejection messages.

• Perform special projects and other duties as assigned by supervisor or manager with Given deadlines.

• Research insurances and keeping up-to-date with insurance requirements and billing guidelines.

• Work with Managers to establish priorities of pending work, communities with fellow teammates and follows Through to completion in a timely manner.

• Cross trained in all areas of State Medicaid Plans.

• Maintain Daily Productivity Reports and reports any backlog to Supervisor or Manager Communicates potential problems to Supervisor or Manager.

• Complies with all department and company policies and procedures. Neighborhood Health Partnership United Health, Miami, FL Enrollment Representative, 01/2001- 03/2010

• Process all new business and plan changes and membership; make corrections of errors on group and members.

• Receives newborn list from medical management, loads with pending babies and places newborn on review.

• Generates newborn letters every 30 days

• Reviews and process the newborn on review report every 30 days. Maintained audit reports at 90% and higher. Enrollment Representative (Commercial/Government)

• Process new applications in a timely manner as received by underwriting department

• Generate necessary PCP letter and make appropriate corrections to submitted members as designated by manager

• Work within standards as determined by auditing process Administrative Clerk

• Responsible for the creation of the member files accuracy and completion of information in files

• Maintained and organized file room

• Maintained the file tracking system and ensure that all files are easily accessible to the entire NHP organization Burdines 06/1997 – 01/1998 Hialeah, FL

Sales Associate

• Provide full customer service to customers by attending to their needs.

• Cashier duties and responsibilities.

IBely Department Store 01/1997 – 04/1997 Miami, FL Cashier

Responsibilities include, customer service, cashier, stocking and other sundry assignments. Item Processing of America 06/1994 – 06/1995 Bank Clerk

• Make sure all customers’ bank statements are correct.

• Ensure that checks information was accurate before sending

• Them to customers.

Education June 1997 – Miami Central Senior High – Diploma Summary of Skills:

• Microsoft Office

• Microsoft Word

• Window 95, 98 operating systems

• Excel

• Outlook

• Adobe Reader

References Available upon request

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