Clinical Reviewer Service Representative
Resume:
Erica Kelly
Claims Representative
Orlando, FL
*************@*****.***
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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