Customer Service Specialist

KRISTI FRANZ

**** ***** **** **************, ** *7130 cell: 812-***-**** e-mail: **********@*****.***

SUMMARY

** ***** ** ********** ******* cycle management, and customer service support operations and office management. Seeking a new position in administrative, customer service, contracting, and or financial support operations.

EXPERIENCE AND ACCOMPLISHMENTS

ZEPPA'S LAWN SERVICE Louisville, Ky Office Manager 6/22 – 10/22

Working in Quick Books system created and maintain accounts receivable while coordinating accounts payable to ensure monthly payments are scheduled properly.

Engaged with individuals whether in person or via telephone to help identify their needs to become a long time

customer.

Conducted morning meetings with staff and employees to address any issues and daily suggestions to ensure

a team concept.

NORTON HEALTHCARE Louisville, KY Cash Application Specialist 04/2001 to 05/2022

Analysis Activities

Have exceeded performance evaluation goals for productivity requirements on refunds and patient account adjustments.

Processed reimbursements for patients, private payers and public payers (e.g., Medicaid, Medicare, Passport, Passport Advantage, etc.) while assisting with cash account posting activities.

Researched credit balances on patient accounts to reconcile customer service issues on a daily basis.

Analyze contract payment records to determine overpayments made by the insurance companies and patients.

Coordinated with managed care payers to correct patient account billing issues for correct DRG, CPT, and ASC classifications.

Managed Medicare accounts to determine parties liable for overpayments.

Prepared quarterly reports on Medicare on patient account overpayments and coordination of benefits (COB).

Managed and updated spreadsheets (monthly) for overpaid accounts on inpatient and outpatient services.

Research Kentucky Medicaid system to reconcile overpayments and ensure Medicaid retractions are made.

Reviewed Medicare claims on MedA system to assess claim status and determine any needed actions.

Training Activities

Educated new hires on daily processing of patient account analysis, reimbursement, and adjustment duties to resolve account discrepancies.

Served as team lead for refunds department for ensuring account issue resolution in a timely manner.

HUMANA, INC. Louisville, KY Provider File Maintenance 10/99-2/01

Updated service provider directories for various states.

Worked with market channel managers to verify provider-group-Network (IPA) information.

Maintained Humana physician credentialing and service fund system.

HUMANA, INC. Louisville, KY Customer Service Specialist / Representative 3/97 - 10/99

Promoted to customer service specialist.

Provided member benefit services to members, providers, and marketing channel partners across Kentucky.

Processed claims and conducted follow up activities on contracts to ensure issuance of payment.

Provided insurance claims benefit services to members/providers/agents in nine different markets.

Performed updating of member records using the Customer Interface System.

Answered member questions on claim status using Humana customer relationship management (CRM) system.

Processed data transfers on customer claims to the appropriate departments.

SKILLS & EDUCATION

Computer- MS Word and Excel, Express Claims, Passport OneSource, Availity, Norton patient records system on EPIC, Meditech, Onbase, Hyland Papers (electronic EOB system), Outlook, Harvest, Med-A, Navinet and

Emdeon (electric claim filing system).

Education- Norton Healthcare- completed required annual administrative company-wide training courses.

Education- Humana customer service training programs and medical terminology exam.

Education- Western High School (Diploma). Louisville, KY

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