Service Representative Data Entry
Resume:
EZ
Elona Zenon
Professional Summary
Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty.
Passionate about promoting lasting customer satisfaction by delivering quality service and unparalleled support. Proficient in customer service best practices and related options.
Work Experience History
BCforward /Anthem - Broker Services (Remote)
Indianapolis, IN
08/2022 - 03/2023
BCforward/Anthem - Dental Claims Processor (Remote) Indianapolis, IN
11/2021 - 08/2022
Managed over 50 customer calls per day from member and provider regarding dental claims and benefits. Verifying dental benefits, such as COB, Annual Maximum, Ortho coverage and submitting written and verbal adjustment for dental claims. Verify in-network and Out network provider benefits.
Molina Healthcare - Medicare Member Service Rep
Long Beach, CA
01/2015 - 05/2019
● Managed over 50 customer calls per day.
Responded via telephone and email to questions regarding licensing, commissions, website logins and website navigation.
●
Provided customer support and follow-up with members as assigned, implementing exceptional problem-solving and management and responding appropriately to inquiries.
●
Answered inquiries and provided information to Brokers, distributed appropriate paperwork, and fulfilled requests to deliver excellent customer support.
●
**********@*********.***
Los Angeles, CA 90043
Skills
Twenty - five years of experience
working in call center and 5 years
knowledge experience healthcare
environment. Fast learner, self-starter
with positive attitude. Ability to work
on many different systems and tools.
Skilled in handling heavy inbound and
outbound calls (75-100 calls).
Experience in greeting customers,
filing, faxing, troubleshooting,
processing payments, setting
appointments, loan modifications, pay-
off demand, resolving complex issues
and wining customer loyalty. Local
candidate with excellent
communication and interpersonal
skills
● Microsoft Office
● MEDICARE (5 years)
● EMR
● EXCEL
● MICROSOFT WORD
● Call Center
● Customer Service
● Customer Care
● CSR
● Medicaid
● Customer Support
● Computer literacy
● Medical terminology
● DENTAL (2 years)
• TECHNICAL SUMMARY:
Microsoft Word, Excel, Outlook, Type
●
•Managed over 50 customer calls per day from members with complaints, billing questions and payment extension/ service requests.
• Calmed down angry callers, repaired trust, located resources for problem resolution and designed best option solutions.
• Assisted members with healthcare benefits.
• Assisted and processed enrollment telephonic agreement during annual re-enrollment period.
• Knowledge of HIPAA, EOC, EOB, formulary, Medicare, medical, dental benefits.
• Provided and verified eligibility of health coverage to providers. • Handled grievance and appeals, insurance verification, empathy and compassion for seniors and disable members. Provides new and existing members with best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain and increase member relationships. Recommends and implements programs to support member needs
Molina Healthcare - Care Review Processor
Long Beach, CA
08/2014 - 11/2014
Works within Care Access and Monitoring (CAM) team to provide clerical and data entry support for Molina Members that require hospitalization and/or utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to appropriate Health Care Services staff to ensure delivery of integrated high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for Molina Members. Essential Functions
• Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including:
o Verify member eligibility and benefits,
o Determine provider contracting status and appropriateness, o Determine diagnosis and treatment request
o Determine COB status, o Verify inpatient hospital census-admits and discharges o Perform action required per protocol using the appropriate Database
• Meet department productivity standards.
• Respond to requests for authorization of services submitted to CAM via phone, fax and mail according to Molina operational timeframes.
• Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by Medical Director.
• Provide excellent customer service for internal and external customers.
• Meet department quality standards, including inter-rater reliability
(IRR) testing and quality review audit scores.
• Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.
40 wpm, .HIPAA, EOC, EOB, Drug
Formulary, Eligibility Benefit and
Verification Coverage, CRM, MC-400,
I-Series 400, Medical, Medicare, Part
A&B, C & D, Dental and Vision
Coverage, ICD-9 and CPT Codes,
Proficient using EMR, 10 key (10+
years)
Education
06/1993
Certificate in NAACP
Los Angeles, CA
Certification : Customer Service
Management
06/1983
Florence Crittentn
Pasadena, CA
High School Diploma
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Participate in Care Access and Monitoring meetings as an active member of the team.
• Meet attendance guidelines per Molina Healthcare policy.
• Follow "Standards of Conduct" guidelines as described in Molina Healthcare HR policy.
• Comply with required workplace safety standards. Knowledge/Skills/Abilities
• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Working knowledge of medical terminology and abbreviations.
• Ability to think analytically and to problem solve.
• Good communication and interpersonal/team skills.
• Must have high regard for confidential information. • Ability to work in fast paced environment.
• Able to work independently and as part of team.
• Computer skills and experienced user of Microsoft Office software. • Accurate data entry at 40 WPM minimum.
Humana - UM Authorization Assistant
Signal Hill, CA
01/2014 - 03/2014
Accurately enter required information (non-clinical and structured clinical data) into computer database for Pre Auth claims for payments for approval and denial claims Utilize ICD-9 and CPT Codes To ensure that aides are paid on timely manner Preview billing for errors in service codes, service dates, service authorizations or other issues Follow up with coordination team to obtain missing authorization/preapproval to bill Review "billed not exported" report & take corrective action Review & Correct return/denied billing Save various e-billing & invoices files on shared drive Any other duties as directed by management
Altegra Health (Formerly) The Coding Source - Project Outreach Specialist (Call Center)
Los Angeles, CA
07/2013 - 11/2013
• Contacted provider offices via phone to schedule medical record technicians to go on-site to retrieve health records that are then uploaded into systems to be coded by medical coding staff.
• Contacted health plan members to schedule office or home visit by a physician, and as well to offer health plan members different social services that may qualify for in Los Angeles.
• Supported incoming calls from coders, medical record technicians, provider offices & health plan members
• Prepared, sent, and received provider & member correspondence
• Reported on productivity
• Prepared other reports and reconciled scheduling data. Also verified all forms receive in office to be complete.
• Performed special assignments as required
SCAN Health Plan - Member Service Representative
Long Beach, CA
09/2011 - 03/2013
• Managed over 50 customer calls per day from members with complaints, billing questions and payment extension/ service requests.
• Calmed down angry callers, repaired trust, located resources for problem resolution and designed best option solutions.
• Assisted members with healthcare benefits.
• Assisted and processed enrollment telephonic agreement during annual re-enrollment period.
• Knowledge of HIPAA, EOC, EOB, formulary, Medicare, medical, dental benefits.
• Provided and verified eligibility of health coverage to providers.
• Handled grievance and appeals, insurance verification, empathy and compassion for seniors and disable members.
• Made outbound call to new members with diabetes welcome them to new plan and to discuss diabetic supplies
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