Entry Specialist Operator

Michelle Gardner

**** *********** **** *********, ******** 21244

410-***-**** home or email @ *******@*****.***

CAREER OBJECTIVES

To obtain a position where my skills can be utilized and offer opportunity for advancement with your company.

PROFESSIONAL EXPERIENCE

Woodholme Gastroenterology/Lifebridge Health 10/2016-Present

Receptionist/ Medical Secretary

Schedule appointments for procedures

Input demographics, verify insurance, check in patients

Make follow up calls, confirm appointments, provider postings, clinicals

Greet patients and get them prepared to have procedures

Maintaining a smooth running communication base among the endoscopy patients, and the endoscopy team

Acting as a “Centre Representative” and a “Public Relations” liaison

Presenting a warm, pleasant, and welcoming demeanor to patients at all times

Answer patient questions and gives information within the limits of his or her knowledge

Robert Half/Account Temps@ Woodholme Gastroenterology 03/2016-10/2016

Data Entry Specialist/Front Desk Receptionist

Verified medical insurance, tracking and entering all charges for the hospitals and offices

Posting payments for procedures

Reconcile records

Provide consent forms for procedures, collect copays and deductibles

Provide professional customer service, scan documents into system

Entering physician practice and endoscopy center fee tickets, referrals

Investigating all paperwork to make sure all proper documents are received

United States Postal Service 10/2015-12/2015

City Carrier

Sort/Scan mail and packages for residence and business delivery

Sort packages according to zip codes

Provide safety procedures with driving and delivering

Provide proper forms for certified/priority mail or packages that requires signatures

Lifestar Response 12/2012-10/2015

Medical Biller-Medicare

Verify insurance information: Basic Life support, Advance Life Support

Handle customer service calls in reference to bills

Making payment plans, paying co-pays or credit card payments

Make determination to either bill for payment or deny based on information given

Resolve customer complaints

Amerigroup Community Care 10/2007–08/2012

Medicare Marketing Analyst

Maintain enrollment and utilize CMS database and internal processes to ensure timely and accurate processing of membership applications

Coordinate and prepare documents such as Sales Productivity Reports, Enrollment Application Reports, Commission Calculations and Submissions, and Retention Reports. Also enhance and refine core ongoing reports

Collaborate with Compliance and Medical Management to analyze disenrollment trends

Work on other special projects as needed

Act as SalesForce.com liaison between plan and Virginia Beach ensuring data is updated and relevant for reporting and tracking purposes, impacting overall marketing activities

Ensure all enrollment forms are processed and submitted to Virginia Beach enrollment department and CMS, preparing all enrollment communication and back-up paperwork

Dr. Victoria Staiman, MD-Chesapeake Urology 10/2006-04/2007

Claims Entry/Front Desk Support

Acknowledge, Check-In, Check-out Patients

Scan insurance cards, collect co-pays

Answer telephones, Schedule/cancel/confirm appointments

Print daily schedule reports/pull patients charts

Enter demographics and insurance information

Processed all medical billing for (8) physicians: office visits, labs, surgeries

Elderhealth Incorporated/Bravo Health 02/2002-08/2006

Outreach Benefit Specialist

Outreach to members about programs with prescriptions, HMO benefits

Being an assistant Team Leader and a member advocacy for the Health plans

Customer Service/follow-ups/documentation

Resolution with Dept. of Social Services and other Agencies

Submitting applications for approvals and providing State/Federal Guidelines

Trainer

Train new hires on system operations

Reviewing the manual of the different health plans to be tested

Being a mentor and resource agent

BlueCross/BlueShield of Maryland

Insurance Overload Systems 04/2000-02/2002

Customer Service

Answering incoming calls and resolving member issues

Tracking and sending claims to proper department

Claims Processor

Processed PPA (Potomac Physicians) claims. Dental, Medical, PT OT, ST

Input insurance information

Re-direct to proper location/Provider Inquiry/Special Projects

Suspend for proper authorizations

Advanced Radiology, Baltimore, MD 07/1999-04/2000

Customer Service Representative

Answering incoming phone calls in relation to Radiology/X-Ray billing

In-Put insurance information

Re-direct calls to proper location

Bill insurance’s, Attorney’s, Workman Compensation, Self-Pay, Automobile Accidents

Adjustments, Co-Pay issues, Referrals

Make Collection Calls

United Healthcare, Inc., Baltimore, MD 02/1998-07/1999

Claims Analyst II

Processed Medical, Dental, Specialty claims CPT/ICD-9 coding

PT, OT, ST handled customer service and member service issues

Investigated health insurance provider relations

Special Projects

Database-member service modules

Adjustments/Provider Inquires

Quantity/Quality control

United Healthcare, Inc., Baltimore, MD 09/1996-02/1998

Data Entry Operator

Keyed in Medical, Dental, Claims, Suspension for review

Investigation Provider/Member look-up

Became Specialist for Provider/member look-up

Handles large volume of work (300+ claims per day)

EDUCATION

Villa Julie College, Management Science/Nursing, Stevenson, MD

Coppin State University, Management Science/Nursing, Baltimore, MD

PROFESSIONAL DEVELOPMENT

Dean Vaughn Medical Terminology

Contact this candidate