Service Representative Customer
Resume:
MARY REED
*********.******@*****.***
PROFESSIONAL SUMMARY
Excellent, written and verbal customer service skills advanced computer skills. Thorough knowledge of SNV, HHA, OT, PT, and ST visits and how they are billed Accurate accounting skills with ten-key by touch
Over ten years of medical terminology ICD-10 and CPT codes Billing and collection procedures expert with thorough knowledge of Appeal's Patient chart auditing ability
Thorough knowledge of DRG, UB04 and HCPC coding guidelines Thorough knowledge of commercial and private insurance carriers and COB Thorough knowledge of legal terminology, Discovery, Lexus Nexus, West Law etc. Call Center Certificate
EDUCATION
Associate of Science: Business Administration,
Draughon’s Jr. College - Nashville, TN
Paralegal Certification: Law
Southeastern College – Nashville, TN
Currently enrolled online in a Customer Service, Administrative Assistant, Microsoft and Excel to stay aware of any changes or improvements within my field. EMPLOYMENT HISTORY
2/2015 to present
Mac's Solutions
Preparing Contracts
Taking customer calls, making calls to customers
Keeping necessary records for the business
This was part-time and PRN.
Receptionist/Customer Service Rep - 01/2013 to 01/2015 AppleOne Employment Agency – Brentwood, TN
I worked temporarily while I was married.
I worked doing Receptionist and administrative work, such as checking home loans for completion, answering telephones, entering information into the computer and did basic office work
Worked as a Customer Service Representative for Aetna Office Team Employment Agency - 9/2014- 10/23/2014 I only worked one month for Office Team but worked consistent for AppleOne. Worked at Tennessee Health Connection taking calls for insurance regarding TennCare, Medicaid, Cover Tenn. etc., provided benefit information also how and where to apply Patient Acct. Rep - 03/2012 to 07/2012
Pride staff Employment Agency – Nashville, TN
Worked patient accounts and made adjustments, re-billed claims, filed appeals and medical collections
Precisely completed appropriate Appeal's, documentation and system entry Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical claims and patient accounts
Maintained updated knowledge of coding and billing requirements Verified patients' eligibility and claims status with insurance agencies Diligently filed and followed up on third party claims Determined prior authorization for patient procedures Researched questions and concerns from providers and provided detailed responses Compiled and tracked outstanding balances owed to medical facilities Prepared billing correspondence and maintained database to organize billing information Medical Records Clerk - 11/2011 to 03/2012
Randstad Employment Agency-Nashville, TN
Sorted, filed and copied medical records and answered the telephone and filed medical records Answered telephone and called on outstanding accounts Team Lead/Receptionist - 11/2010 to 09/2011
American Esoteric Labs – Nashville, TN
Billed all lab charges for Nursing Home's, Physician's and Clinic's Collected on all facilities billed
Handled all correspondence and issues from the facilities and insurance companies Answered all calls concerning billing and collections Made corrections in DDE for Medicare claims and re-bill Worked all Medicare, Medicaid and commercial insurance appeals Handled all prior-authorizations when needed
Interviewer II - 12/2008 to 10/2010
Tennessee Department of Labor – Nashville, TN
Interviewed unemployed claimants over the telephone to obtain necessary information to determine eligibility for unemployment checks, according to the laws and guidelines of Tennessee.
Explained and interpreted unemployment program guidelines and regulations to claimants Entered all information needed on statements for Adjudicator's and completed all documents necessary for their decision making process
Contacted employers to verify claimant work history, discharge or quit information Maintained daily claimant information file for any required follow up Traveled to other cities in Tennessee and took TRA federal claims Customer Service Representative - 05/2008 to 07/2008 Cigna Government Services /Judge Temporary Service – Nashville, TN Worked in Medicare Customer Service Department, informing Durable Medical Equipment Providers of how to bill their Medicare claims correctly Answered questions about Medicare billing guidelines and regulations Documented questions and answers on Excel spreadsheet Administrative Paralegal - 06/2006 to 05/2008
Platinum Realty – Nashville, TN
Prepared documents needed in property closing appointments. Prepared files for each client or Realtor
Processed all office accounting
Talked to buyers and sellers about property listings Administrative Paralegal - 09/2005 to 06/2006
Tennessee Department of Human Services – Nashville, TN Audited TennCare accounts for accuracy or fraudulent information Prepared legal documents for TennCare hearings
Corresponded with claimants and Attorneys on TennCare Contracts and hearings
Reimbursement Specialist - 02/2000 to 07/2005
DaVita Healthcare – Brentwood, TN
Collected outstanding insurance balances on patient accounts and insurance Audited and billed claims for payment corresponded with insurance companies about contract payment errors Maintained running balances on insurance payments and payment retractions Maintained Excel spreadsheet on all accounting transactions and insurance follow up Verified insurance for coverage, deductible, out-of-pocket, in or out of network Corrected patient accounts with billing and or payment errors
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