Service Representative Claims

Patricia Hamilton

**** ***** ******

Philadelphia Pa 19145

Phone# 267-***-****

********************@*****.***

Skills and Experience :

I possess 30 years of office clerical experience, 20 years of experience using the Microsoft Windows Office Suite and Internet Applications, 30 years of experience in customer service and customer relations,15 years in payroll, 13 years working in a medical environment, and 7 years in a call center.

October 2021- November 2022

Hospital of the University of Pennsylvania

Access Service Associate

At the Hospital of the University of Pennsylvania I was part of a large team of schedulers broken down into entities of different medical specialties for one of the top rated hospitals in America. My responsibilities are as follows:

I maintained phone protocol and etiquette when speaking with patients, physicians and others that call to schedule an appointment, leave a message for their physician or nurse or any other issue they had.

I took inbound calls to schedule appointments for the Neurology department. I set up new patient charts in the system

Verify the patient's insurance

I advised patients of all instructions and requirements for their visit. October 2007-May 2020

Mercy Home Health Philadelphia, PA

Clinical Team Assistant

At Mercy Home Health I was part of a team that is growing with expediency here in Philadelphia and its surrounding counties, Delaware and Michigan. My responsibilities were as follows:

· I was the time keeper for the Philadelphia Office making sure all employees' time was accurately entered and submitted for payroll.

· Previous duties included, payroll and mileage for the Philadelphia Office.

· Ordered of all supplies, SOC packets and other materials for the clinicians.

· Kept a stocked supply closet of medical supplies and PPE equipment for clinics

· Assisted three nurse managers, an education team and PI team.

· Set up for team meetings and branch celebrations

· Maintained phone protocol and etiquette when patients, physicians and others called with issues concerning care.

· Handled all incoming and outgoing mail

· Maintained the office façade by making sure everything had a place and also by keeping in touch with building management when something needed to be fixed.

· I assisted the IT dept. when a clinician needed help with setting up new equipment. May 2016- December 2016

Independence Blue Cross Philadelphia, PA

Client Services Associate

I was part of vast team of customer service representatives in one of America’s #1 medical insurance companies. My responsibilities were as follows:

· Received inbound phone calls from members.

· Explained medical benefits, eligibility, and answering questions the member may have about their coverage.

· Examined claims for errors by the provider and or by the claim examiner, making sure those claims are reprocessed correctly.

· Ordered ID cards and other reading material such as benefit packages for members.

· Made outbound calls to other insurance companies and providers to ensure the members claims will process correctly and to gather information about other insurances the member may have.

· Referred issues to the proper departments with follow up to make sure the issue was handled in a timely manner.

· I also advised members about their dental, vision, pharmacy and mental benefits. February 2002 - October 2006

KEYSTONE MERCY HEALTH PLAN

Provider Claims Service Representative

January 2001 - November 2001

THE SIGNAL

Customer Service/Claims Representative

Start year: 1993 End year: 1999

WELLS FARGO

Teller Coordinator

Computer Skills:

EPIC, Microsoft Windows Office Suite and Internet Applications, Kronos, HCBC -Home Care Home Base, Navinet, Availity, PEAR

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