Data Entry Support Representative
Resume:
CHINITTA THOMAS
404-***-**** cell ********.******@*****.***
Highly-qualified customer support professional offering more than 8 years of experience and specialization in providing customer services.
Key competencies include:
Proven track record in putting expertise to practice.
Enjoys assisting clients – Effectively communicates and solves technical issues.
Team player – Passion for learning/sharing knowledge and troubleshooting
Ability to communicate and make appropriate decisions in a concise manner.
Intelligent and highly motivated with a high-level of patience.
October 2021 - Current Sagility (Virtual) Westminster, CO
Claims Processor
●Reviewing and Resolving healthcare claims
Analyzing claims to determine whether or not the claims should be approved or denied for payment.
●Reviewing and addressing provider inquiries regarding claim adjudication
●Meeting all required metrics for the position
●Applying knowledge of medical coding and various medical claims forms to the claims process.
March 2021 – July 2022 CareSource (Virtual) Dayton, HO
Provider Advocate Representative
●Assisted providers with service inquiries including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures on Medicaid members.
●Proficient in all sites relevant to medical claims; Scion, Facets, Instamed, OnBase, Cactus, Streamline and Medicaid GA GAMMIS.
●Liaise between the provider, CMO, hospital regarding credentialing and provider enrollment.
●Status updates for enrollment process for Georgia through Onbase, and Ohio through Onbase and Cactus.
●Utilized Facets to assess claims tools to identify if reprocessing is appropriate/ reroute claims to be reprocessed.
●Reviewed claims with providers and provider representatives to determine if claims will be released for reimbursements through Instamed.
●Assist providers with determining the amount of the codes based on the GA Medicaid Gammis Fee schedules.
●Identified and acted on claim takeback opportunities.
●Assist providers with issues regarding the company portal; password reset, registering for a new account, troubleshooting portal issues.
December 2019- March 2021 Broadpath (Virtual) Phoenix, AZ
Provider Representative
●Receive and respond to telephone inquiries from providers regarding eligibility, benefits and authorization of services for Medicare Advantage members.
●Responsible for verifying member coverages, benefit types, eligibility dates, and claim payment/statuses for providers.
●Estimate Medicare member’s out of pocket expenses for procedures or services and explain member copayments.
●Document all call information per approved operating procedures.
●Use tools and problem-solving skills to identify caller needs, including potential crisis calls, and route calls to appropriate resources per standard operating procedures.
●Assist providers with enrollment status and provide direction for new enrollees.
February 2017 –November 2019 CareSource (Virtual) Atlanta, GA
Provider Advocate Representative
●Assisted providers with service inquiries including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures on Medicaid members.
●Proficient in all sites relevant to medical claims; Scion, Facets, Instamed, Streamline and Medicaid GA GAMMIS.
●Utilized Facets to assess claims tools to identify if reprocessing is appropriate/ reroute claims to be reprocessed.
●Reviewed claims with providers and provider representatives to determine if claims will be released for reimbursements through Instamed.
●Assist providers with enrollment status and provide direction for new enrollees.
●Assist providers with determining the amount of the codes based on the GA Medicaid Gammis Fee schedules.
●Identified and acted on claim takeback opportunities.
●Assist providers with issues regarding the company portal; password reset, registering for a new account, troubleshooting portal issues.
Chat Support Representative
●Efficiently responded to internal and external customer requests via chat.
●Provided service support for providers, verifying eligibility, explanation of benefits, claims and appeal procedures.
●Performed first-level core troubleshooting on software system problems and delivered accurate technical solutions.
●Processed critical issues when additional assistance was required by referring user problems to specialists, supervisors, or other support groups.
Member Advocate Representative
●Assist GA Medicaid members with routine service inquiries including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquiries, resolving member complaints, identifying and filing member grievances.
●Provide quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for timely resolution.
●Capture Medicaid member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business.
●Process enrollment process for GA Medicaid members
●Ensure all HIPAA and State requirements/regulations are adhered to at all times, in existing and future lines of business.
●Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction.
●Build and strengthen member relationships by providing quality customer service.
July 2016-February 2017 Randstad Staffing Atlanta, GA
Amoena
Customer Service Representative
●Accurate/Timely Data Entry of incoming orders (Email, Fax, or Telephone) and returning order confirmation to retailers (B2B) customers in a timely manner.
●Create and Process Returns, Warranty returns, Promos, Credit memos and other defined communication/processes to both internal and external customers.
●Initiate research and evaluate all relevant information to handle inquiries, complaints, and data entry errors for possible solutions.
●Demonstrate expert knowledge of products.
June 2010-June 2016 Verizon Wireless Alpharetta, GA
Management Support Team
June 2010 -November 2016
●Assist Front line representatives with escalated calls and build customer relationships to drive customer satisfaction and loyalty.
●Offer floor support for Supervisors when they are none available.
●Troubleshoot complex technical customer issues and escalations.
●Demonstrate best judgment in the disbursement of adjustments and credits to increase company revenue.
PROFESSIONAL SKILLS
Scion, Facets, Instamed, Streamline, GA GAMMIS, CVS Caremart, EncoderPro, OnBase, RadMD
VZW Systems: SalesForce, ACSS, Doorwarys, ITTS, DIMOND, Swiftview
Microsoft office suite: Outlook, Word, Excel, Access, PowerPoint
EDUCATION
ICode Academy
Certification in Medical Billing and Coding (Aprintaship)
Point University
A.A. Organizational Leadership
References Available Upon Request
Contact this candidate