Service Representative Medical Coding
Resume:
Miguel A. Zamora
*** **** ** ********, ** *****
Work Email: ******.******@******.***
Personal Email: ***********@*****.***
OBJECTIVE: To obtain a challenging and rewarding position and that seeks an enthusiastic individual with excellent communication, interpersonal, and organizational skills.
EDUCATION:
University of Phoenix:
Bachelor of Science in Healthcare Management
Graduate: July 2022
Kaplan College
Associate of Applied Science Medical Practice Management
McAllen, TX August 2011
Medical Practice Management Training/Skills
• Interpersonal Communication • Medical Records/ EMR
• Medical Coding • Medical Office Accounting
• Advanced Medical Coding • Management in the Medical Office
• Psychology • Professionalism in the Health Services
• Human Resources Management • Applied Medical Practices
• Health Data Management • Health Services Delivery/Legal Issues
• Health Information Technology • Medical Records Management
San Antonio College of Medical and Dental Assistants
Medical Office Specialist Diploma, February 2009
McAllen, TX
EXPERIENCE:
Driscoll Health Plan McAllen, TX
Provider Relations Tech December 19th 2011 – Current
Providing services over the phone to providers and help them with Web Portal issues or will train them step by step on how to navigate the Web Portal. I create usernames and passwords for providers or also reset passwords if necessary. If a provider is not in our system which is Aquity, then I have to go manually and enter each provider so when they try to do an authorization their name will appear.
oOnline Access – Handle all access for both Service areas. Obtain EOP’s, Provider Panel and Train on VTouch (Texas Health Steps)
oWeb Portal – go over on checking eligibility and claim status
oOnline Referrals – train providers step by step on how to check status of an authorization and how to create a new referral.
oClaims Portal – explain to providers that this is our clearing house but would have to go through Emdeon not unless they have one already then they would just keep their own.
oProcess EFT’s for providers.
Assist providers with claim issues and go over their claims to see why they are getting claims denied or any other issue that has to deal with their denied claims.
I do record changes to providers that leave the area, change addresses, add location, add a credentialed provider to a group, change phone numbers, and change payment address.
Encourage providers to get on EFT so that they will not have to be getting a paper check and it just goes directly to their bank account.
Credentialing or re-credentialing providers.
I have to help the reps on getting packages ready for training presentations and Dr. Buck’s trainings.
When a new Provider Rep is hired, I have to train them on how to use each program that provider relations department works with.
At times I have to go with Fred to do one and one trainings at the hospitals for their whole department in which are billing and clinical staff.
When we are short staff on reps, I help them by going on my own to do provider visits to assist them with one and one trainings or answer questions that provider might have about the health plan.
I would help out reach to do weekend events to explain about the health plan to potential members and members.
I create provider invitations and do a fax blast to all possible to have a great turnout at our trainings.
I have to print out mail postage for the whole office and make sure all mail gets out or if I have to drop off a package, I have to go drop it off at UPS or FedEx.
When the boss is out of town he leaves me in charge to make sure things run smoothly and make sure the office is locked and alarm is on at the end of the day.
Kaplan College McAllen, TX
Work Study January 2011- August 2011
• Worked closely with financial and business departments to ensure students made payments and arrangements for tuition; Assisted Education department with posting grades into database.
• Assisted Education department with quarterly audits in accordance to state and federal regulations.
• In charge of library activities when regular staff out to lunch; assisted students create resumes.
Other duties included posting flyers, delivering material to different departments and pulling
students from class when necessary.
Affordable Billing Consultants McAllen, TX
Biller - 270 Hours Externship December 2008 - February 2009
• Processed claims for services provided by a physician through third party carriers like Medicare, Medicaid, and other private insurance.
• Conducted internal review of claim information to verify coverage and coverage amount for particular treatments.
• Reviewed claims to determine status and would resubmit corrected or denied claims, if necessary.
• Verified insurance coverage for the services rendered by physician.
• Performed other duties as assigned.
Ticket Master Pharr, TX Customer Service Representative April 2004 - March 2007
• Served as Floor Lead/supervised agents; Helped agents with resolution of complex issues.
• Received inbound calls from customers seeking assistance in purchasing tickets for concerts, and sports events.
OCCUPATIONAL SKILLS:
• Microsoft Word
• Excel
• PowerPoint
• MediSoft
• Medical Manager
• Bilingual (Spanish and English)
REFERENCES: Available Upon Request
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