Customer Service Eligibility Worker
Resume:
Tammy Davis
************@*******.***
OBJECTIVES
To obtain a position within the capacity of a Healthcare Specialist where I can Demonstrate my superb administrative skills, claims processing mastered
QUALIFICATIONS:
Office Skills
• Telephone etiquette
• Typing proficiency: 40 WPM
• Medical Manager Software
• Patient Scheduling, Accounts Receivable, Claims processing, Insurance Verification
• Prior Authorizations,
Software Proficient
•Zirmed, Waystar, NaviNet, Availity, My CGS, Amazon workspace,
•Dental Trak, Amisys, TrucCare, Portico, Envole,Optum Rx, OMNI
•NPPES, PECOS, EHR, IACS,
•AMSI, SAP, C3, PASSPORT,ECHO,CSI.Docfind
•United Dominion Realty Trust,TASS,RentRoll, YARDI
•
•
WORK EXPERIENCE:
05-2021-Current
Insurance Verifications Coordinator II
Indotronix
Verify existing, new patient insurance coverage for medical supply eligibility and billing purposes, Documentation of patient medical forms, prescriptions, prior authorizations, medical release forms and etc
Re-verification of existing patient insurance coverage to ensure that repeat order cost and eligibility is communicated to the patient and the billing department
Coordinate Prior Authorization Requests, Obtained Home Health admission and discharge details
Utilized provider contact details and provider portals for verifications
11-202*-**-**** San Antonio, TX
Dental Provider Service Rep
MCNA Dental (HAWKINS PERSONNEL)
Determine member eligibility for dental procedures.
Member/Dental provider portal assistance
Explained Dental plan benefits, claim status, processing guidelines, prior authorizations and referral status.
Assigned /updated dental provider.
Issued member materials ID cards, provider directories.
06/2020-01/2021 San Antonio Texas
Financial Transactions Processor (Subpeona Dept)
Citibank (COLLEBERA INC)
Researched Citibank's financial database to purge account information pertinent for subpoena record requested.
Create financial transaction records for subpoenaed individual & commercial accounts.
Captured Images of check and or deposits & created Adobe presentations of financial reports found.
Verified accuracy of transactions found, then submitted to Subpoena Manager for approval
10-201*-**-**** San Antonio, Texas
Medicare Member Service Rep
Centene Corporation
Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
Aided members and/or providers regarding website registration and navigation.
Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
Process written customer correspondence and provide the appropriate level of follow-up in a timely manner
Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
Work with other departments on cross functional tasks and projects
Maintain performance and quality standards based on established call center metrics including turn-around times
Provider Services Prior Authorization Rep
Broad Path Healthcare Solutions
Determine network status and eligibility for Medicare Advantage Providers
Establish the requirements for prior authorizations through CPT code checks.
Provide eligibility status of member for Dates of Service.
Performed HIPPA verifications for Medical Provider and Members for service eligibility
Navigate various systems for Prior Authorization acceptance, processing status and completion for submission
07-201*-**-**** San Antonio, TX
Medical Benefits Specialist Medicare & Retirement, Employer and Group
United Healthcare
Exceed standards of customer service through timely, courteous and diplomatic handling of internal and external customer interactions.
Communicate effectively with Medical Providers and insured members to address all needs within claims processing
Prompt follow up on claim reconsiderations and review of previously processed claims.
Proficient in using the phone/claim/image systems and various sub-systems
Knowledge of various contracts including PPO, HMO, special marketing arrangements, and service guarantees.
Verify benefits and eligibility for any services rendered, issue overrides and exceptions for pharmaceutical needs and understand how they interrelate to ensure claims are processed appropriately
Review and process medical claims to support the departmental responsiveness and accuracy standards
Provide second review on claims
Issue ID cards, assist with access to myuhc account
Demonstrate provider look up for INN/OUT of network to assure members can utilize the benefits to better assist their needs.
05-201*-**-**** Ameritas Life Insurance Corp. San Antonio, TX
Provider Benefits Claims Specialist
Ameritas Life Insurance Corp
Exceed standards of customer service through timely, courteous and diplomatic handling of internal and external customer interactions.
Communicate effectively with dental, vision and hearing professionals, and insured members responding to the special needs of participating providers.
Prompt follow up on claim reconsiderations and review of previously processed claims.
Proficient in using the phone/claim/image systems and various sub-systems
Knowledge of various contracts including PPO, special marketing arrangements, and service guarantees.
Recognize procedure codes, tooth numbers, etc. and understand how they interrelate to ensure claims for all products were processed appropriately
Review and process dental, vision claims to support the departmental responsiveness and accuracy standards
Provide second review on claims
04/2014-12/2014 TRC Staffing, San Antonio, TX
Cust Care Agent (ACE /DPL Contract)
Administered great customer service for customers regarding their utility account(s)
Obtained information from customers by phone regarding orders for; installation, disconnection, and transferring service, assisted with billing inquiries such as payments, arrangements.
Resolved customer complaints
Update and document information in CRM database
10/2013- 03/2014 Atterro Inc, San Antonio, TX
CSR Admin Tier 1 (CGI Contract)
Provided excellent customer service to Health Care providers participating in Medicare billing
Utilized IACS system to validate and secure accounts for PS&R/STAR users
Assisted with new user registration for CMS (centers for Medicare/Medicaid services applications
As well as PECOS, NPPES and Electronic Health records for Medicare processes.
Provided navigational assistance with Medicare Enrollment, Revalidations, Re-assignment of benefits
And other processes and technical issues, secured accounts and provided to users according to CMS security policy.
04/2013- 07/2013 Aerotek, San Antonio, TX
Tier 2 U-Verse Technician (Contract)
Demonstrated advanced troubleshooting techniques such as Assisted customers in re-securing accounts, such as password and pin resets, updated payment and billing info, retrieve data lost due to equipment replacement Handled in and outbound calls from customers needing all types of troubleshooting assistance, performed various troubleshooting tasks for U-verse services, and limited help with bill pay. Created accounts and submitted repairs to dispatch, consulted with many departments throughout AT&T data base to assist as needed.
06/2012- 12/2012 Volt Management Consultants, San Antonio, TX
IOS Technician (Contract)
Demonstrated advanced troubleshooting techniques such as Uninstalled programs, granted access to user accounts, reset user account info.
Retrieve data lost due to a restore or invalid backup, assisted in the navigation of Apple Software and Applications installed,
Handled in and outbound calls from customers needing all types of troubleshooting assistance, performed various troubleshooting tasks for iPhones, iPads, iPods and limited help with Macintosh computers. Created accounts and submitted repairs to dispatch, Handled processes for refunds due to in- app purchases and mistakes made in the iCloud and iTunes accounts
02/2012- 05/2012 LK Jordan SAHA Westway Apartments, San Antonio, TX
Client Service Specialist (Contract)
Determined eligibility of applicants for the San Antonio Public housing program, Calculated and assigned tenant rent. Resident processing collecting payment from tenants for current and past due rent.
04/2011- 12/2011 LK Jordan SAHA Wheatley Courts, San Antonio, TX
Administrative Assistant (contract)
Performed various tasks as an admin such as Resident processing collecting payment from tenants for current and past due rent. Created as well as closed work orders for tenants, assisted in the completion of applications for placement in apartment community and waiting list for Public Housing, maintained phone calls throughout the day,received and delivered mail to proper locations throughout SAHA,Navigated ELITE systems to no resolve tenant concerns, post payments to bank for proper payment, maintain daily log for payments received, notify applicants of our vacancies and all procedures to become an eligible applicant for Public Housing
04/2009-02/2011 Benbrook Clinic, Fort Worth, TX
Medical Office Administration
Maintained phone lines, processed patient files, greet patients upon arrival for exams, obtained necessary info such as identification, insurance cards, screening forms and consent forms, scheduled appointments, update patient info, copied and disbursed patient charts, and conducted follow- up appointments.
10/2007/-02/2009 Housing Authority of Contra Costa County, Antioch, CA
Eligibility Occupancy Specialist
Determined eligibility of applicants for the Housing Choice Voucher program, Calculated and assigned tenant and landlord portions of rent for Section 8 vouchers by following HUD calculating procedures and HUD procedures and CFR’S, Negotiated total contract rent according to applicants’ annual income, Processed 3, 30 and 60 day notices, Handled all changes within the household such as: total income, voucher size, rent increase or decrease as well as scheduled inspections, Prepared manual check requests for landlord immediate payments
03/2005-06/2007 Sunbelt Restoration, Tampa, FL
Insurance Claims Representative
Processed Insurance claims for hurricane victims, collected data from insurance statements and from the adjusters’ scope notes according to data collected, estimated claim by learning and searching through Xactimate 24 computer systems, saved data retrieved to PDF files to be sent to the Corporate Offices, Gained the knowledge to comprehend the differences in roofs, ceilings, and 4 types of insurances and their policies. Learned different measurements, scope sheets from adjusters and contractors’ notes Filed and saved claim to the computers NERC -E files
Determined the amount of claim according to the enrollment date s, coverage types, forms, etc.
01/2004-03/2005 Laurel Oaks Apartment Homes, Temple Terrace, FL
Leasing Agent
Handled 3-4 lines of inquiring individuals wanting to know the requirements for leasing, also concerning the community
Processed all work orders and complaints into the United Dominion Realty Trust Rent Roll Systems
Demonstrated proper safety precautions while showing apartment model by obtaining proper Identifications, completing Guest cards, notified tenants of any late fees, utility payments that were due /past due, collected all Rent and Utility deposits for new Tenants, Performed Income and Past landlord verifications conducted credit checks from time to time, assisted manager and new tenant in signing and preparing lease, explained lease terms and procedures
01/2003-01/2004 Tampa Housing Authority, Tampa, FL
Eligibility Worker
Performed third party verification for tenant file for section 8 and public housing by using fax, phone, e-mail, and U.S mail.
Gained the knowledge in providing assisted living counselor with 9-13 files a day processed and approved for a housing voucher. Handled in and outbound calls about clients’ whereabouts on the HUD waiting list entered all changes in the household such as income, change of address, birth, school enrollment etc. Processed all work orders and complaints into the United Dominion Realty Trust Rent Roll Systems. Gained the ability to perform universal income verifications using TASS systems, performed background and criminal record checks, social security benefits and child support that clients refused to provide. Scheduled and attended meetings with tenants and counselor. Mailed out termination letters to landlords and tenants.
EDUCATION:
Contact this candidate