Customer Service Representative
Resume:
Columbia, SC *****
************@*****.***
Marquitta Hughes
Objective
Managerial support professional interested in sharing my experience working in a fast paced environment demanding strong organizational, time management and interpersonal skills. Trustworthy and discreet and committed to superior customer service. Detail oriented and resourceful in completing tasks and projects in a timely fashion.
Experience
September 2021-Present
Epworth Children’s Home Columbia, SC
Donation Services Specialist
•Conduct research on individuals and corporations for giving and sponsorship opportunities.
•Greets donors and visitors and provide assistance if needed
•Discuss benefits and necessity of donations for the community
•Assist in coordination of volunteer programs
•Prepares Development Committee and Boead Meeting materials/reports as needed.
•Process all donations and send acknowledgements for tax purposes to all donors in Raiser's Edge.
•Maintains database with weekly, monthly and yearly reporting
•Manages ongoing pledges and send updates a set aside in pledge agreements
October 2020 - May 2021
Alorica
Customer Service Representative
•Take customer calls and provide accurate, satisfactory answers to queries and concerns
•De-escalate situations involving dissatisfied customers, offering patient assistance and support
•Informs and offer customers about the company’s new products, services and policies
•Guide callers through troubleshooting, navigating the company site or using the products or services
•Review customer or client accounts, providing updates and information about billing, shipping, warranties and other account items
•Collaborate with other call center professionals to improve customer service
December 2018 - December 2019
Blue Cross Blue Shield Columbia, SC
Claims Processor
•Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members
•Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctly
•Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims
•Researches and resolves claims edits and deferrals. Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicable
March 2018 - July 2018
Apple One Columbia, SC
Accounts Receivable Specialist
•Monitor / research outstanding claim balances using online resources via insurance company portals, telephone calls and e-mails
•Communicate with insurance companies regarding claims and eligibility
•Accurately documented progress of each claim throughout payment cycle
•Ensured the correct ICD-10 and CPT codes were billed properly
•Monitored / resolved clearing house edits, denials, rejections to ensure prompt payment
•Apply industry knowledge to process explanation of benefits for reduced payments and denials
•Utilized industry knowledge and available resources to resolve any and all issues delaying or preventing payment
•Responsible for obtaining medical records and forwarding per insurance company requests
•Prepared and submitted reconsiderations and appeals as necessary to ensure payment
•Prepared and worked weekly reports illustrating aging and denial trends
•Communicate effectively with patients regarding their eligibility, benefits and account balance
August 2017 - March 2018
Kelly Services Columbia, SC
Enrollment Specialist
•Oversees processing of and preparation of new member enrollments for Medicare Advantage
•Analyze Medicare Advantage applications to determine eligibility for enrollment
•Completed dis-enrollments as indicated by member and Center for Medicare and Medicaid Services
•Verified and corrected member eligibility issues in a timely fashion as they arise
•Conducted account analysis to ensure premiums are billed, paid and processed properly
•Analyze and process returned funds as indicated by banking institution
•Process payments on all member accounts
•Process over payments / refunds on member accounts and with banking institution
•Inform members of changes to their payment methods
•Analyze member information is equivalent to information provided by Medicare and Medicaid Services and proceed as directed
•Ensure all communication and work processed in accordance to HIPAA guidelines
June 2013 - December 2014
Langley Provider Group Baltimore, MD
Case Manager
•Responsible for communication with Regional Office regarding the status of a Veterans claim for compensation and pension
•Coordinate compensation appointments for claimed medical conditions
•Examine received requests from Regional Office for accuracy
•Responsible for receiving the Veterans medical records and ensuring their availability for scheduled appointments
•Provide Veterans with detailed descriptions of the Compensation and Pension process and answer all follow-up questions
•Return of medical records to corresponding Regional Office once claim is complete
•Ensure all claimed medical conditions are being examined as listed on claim
•Responsible for closing claim once all conditions have been addressed
•Analyze claims open and make sure they are closed within the specified timeframe
•Ensure weekly and monthly reporting of claims are accurate and communicated to management timely
March 2005 - May 2013
Capital Podiatry Associates Washington, DC
Office Manager
•Responsible for daily/weekly/monthly reconciliation of insurance and patient payments
•Analyzed medical records to determine correct IDC-9 and CPT codes to be utilized
•Prepared medical claims to be received by clearing house for processing
•Examined explanation of benefits for reduced and non payments
•Handled appeals with private insurance companies as well as Medicare
•Processed / posted payments from insurance companies to respective patient accounts
•Posted patient co-payments to respective accounts on a daily basis
•Provided quality assurance for patient information and kept patients informed of their account status with the practice
•Responsible for contacting patients regarding past due balances and collecting on those accounts
•Ensured patients are familiar with their rights as outlined by HIPPA laws
•Performed the credentialing process and kept all licenses up to date for all providers
•In charge of employees correctly providing clinical procedures
•Managed procuring and training of all new office equipment and office procedures
•Coordinated outpatient surgical procedures with ambulatory surgical centers and hospitals
•Coordinated travel and public speaking events as well as visual aids needed for events
•Responsible for tracking and payment of vendor invoices in Quickbooks
January 2002- March 2005
Prince Georges Hospital Cheverly, MD
Intake Coordinator
•Greet and direct patients to correct department for care
•Answer all inquiries regarding appointments, ordered tests and required paperwork
•Acquired patient information from walk-in and trauma patients
•Managed the trauma patient information on an emergent basis
•Accurately enter all demographic information in system
•Responsible for scanning clinical information into database
•Work with physicians and nursing staff to facilitate patient encounter
•Inform patients on unpaid balances from previous visits
•Counsel patients on available options to clear unpaid balances
•Received hospital copayments
•Processed and coordinated outpatient procedures for several departments
•Coordinated morgue and funeral home paperwork for cadaver pickups
1997-2002 GMAC/RFC Bethesda, MD
June 1997 - December 2001
GMAC/RFC Bethesda, MD
Loan Administrator
•Understand all title reports, interest rates and compliance issues are accurate as reported by lenders
•Coordinated daily funding as outlined by the lenders
•Ensured EFT’s were transferred as requested by lender
•Managed the sale of loans to other mortgage warehouses
•Manage the limits of lines of credit for several mortgage companies as assigned
•Provide mortgage bankers with funding at closing
•Responsible for the advance and wire transfer origination through electronic funding as directed
•Responsible for receiving and verifying original loan documents from the closing agents/mortgage companies before logging into system
•Follow up with closing agent and resolving issues with incorrect notes
•Accurately deposit note documents according to mortgage companies
•Received Print shipping requests/commitments submitted by mortgage companies
•Log out and ship note to the investor for purchase according to the instructions provided
Education
1991-1994 Woodrow Wilson SHS Washington, DC 1994-1996 Hampton University Hampton, VA
1996-1998 UDC Washington, DC
References Dr. Lawrence Lazar 202-***-****
Capital Podiatry Associates Co-Owner
Sabrina Nicholas 202-***-**** ext. 57979
Veterans Administration Case Manager
Charnita Mathis 301-***-****
Capital Podiatry Associates Medical Assistant
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