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Clinical Reviewer Service Representative

Location:
Winter Park, FL
Posted:
November 19, 2022

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Resume:

Erica Kelly

Claims Representative

Orlando, FL

adtllf@r.postjobfree.com

SKILLS

●Organizational skills

●Problem solving

●Time management

●Critical thinking

●Excellent oral, written and decision making skills

●Exceptional customer service skills

EXPERIENCE

CIOX Health, Orlando FL - Client Service Representative ll

August 2021 - PRESENT

●Handles inbound and outbound calls

●Receives and processes requests for patient health information in accordance with Company and Facility policies and procedures.

●Prepares new patient charts, gathering documents and information from paper sources and/or electronic health records.

●Participates in project teams and committees to advance operational strategies and initiatives as needed

●Acts in a lead role with staff regarding general questions and assists with new hire training and developmental training.

Cooley Dickinson Hospital, Northampton MA- Medical Receptionist

November 2019 - October 2020

●Welcomed patients, accurately updated, and verified patient demographics

●Requested co-pay and outstanding balances on patient account at time of check-in

●Accurately documented appropriate information within the designated office system to maintain accurate records

●Scheduled appts

●Verified insurance information/Billing

●Communicated with other healthcare facilities

●Helped with other administrative task, faxed, filed, emailed, phone calls etc

Health New England, Springfield MA- Health Services Coordinator (temporary)

August 2016 - August 2017

●Maintained productivity standards for authorization entry and letter generating

●Pre-screened criteria-based procedures before redirecting to clinical reviewer

●Made outbound calls to members when issues occurred

●Worked with multiple systems such as Amisys,Aerial, Cypress and Faxpress

●Inputs data in spreadsheets from multiple healthcare facilities

●Verified insurance

EDUCATION

Greenfield Community College, Greenfield, MA - Associate’s of Science Degree in Computer Information Systems- Concentration in Office Management

January 2019

LICENSE

Florida- 6-20 Adjuster All lines

Texas - All lines adjuster

Louisiana- All lines adjuster

CERTIFICATES

State Farm Property Certification

State Farm Auto Certification



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