Service Representative Customer

Phyllis D. Oliver

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

Sacramento, CA 95827

916-***-**** *********@***.***

Objective

To obtain a position that will allow me to grow professionally, while being able to utilize my strong organizational skills and support all clinical and functional activities within the Health Care System.

Education

AAS Heald College Medical Insurance Billing and Coding Major

Graduated January 11, 2014, GPA 4.0

Mentor for the MIBC program at Heald College

Lead mentor with Health Net, UHC and Optum 360

Trained Telecommunication Device for the Deaf.

Professional Work Experience

Refund Collection Specialist – California and Arizona 07/12/2018 – 03/31/2023

United Health Group Optum360, Rancho Cordova, CA

Reviewing patient and insurance accounts within Dignity Health Hospitals if there is a valid refund due to an overpayment and it is due back.

Processed the patient refund and credit it back to the form of payment via credit card or check.

Processed the insurance refund for overpayment via check.

Processed credit card refunds using keypad processing machine.

Patient Financial Service Representative II

United Health Group Optum360, Rancho Cordova, CA 06/13/2016 – 07/10/2018

Ensures quality customer service for internal and external customers calling to make billing payments using Chase System Card Services.

Using trained knowledge of the Managed Care Industry to assist with the Physician’s office, Hospitals and or Clinic to assisting patients on billing claims and processing.

Participates in loading, balancing addressing special projects making any corrections and or adjustments to the patient bills and/or insurances.

Consistently meets established productivity, schedule adherence, and quality standards while maintaining timely and accurate documentations for all appropriate transactions.

Responds to customer service inquiries in writing as necessary.

Monitors delegated customer service issues to ensure timely and accurate resolution.

California / Arizona / Oregon Commercial Benefits and Eligibility

Health Net of California, Rancho Cordova, CA 06/17/13 - 06/10/16

Medicare PDP Customer Service Representative - TEMP

Kelly Services Staffing Agency @ Health Net of California 07/30/12 – 06/17/13

Lead floor supporter for the Line of Business State Health Program representatives on the new system roll out, the lead supporter for the new hire classes and all other representatives within the Call Center in need of assistance.

Assisting in verifying patient hospital medical prior authorizations also know as PA.

Processed credit card payments.

Researched claims according to established policies and procedures.

Sent back to the provider or insurance when needed to be reprocessed.

Accepted inbound ACD calls, correspondence, and provided members with proper explanations of their policy related to Medicare and entering accurate information into the database.

Handled all inquiries including but not limited to benefits and eligibility, appeals process and any Health Net policies to members and or providers, medical and pharmacy services for IFP plans and The Affordable Care Act Plans.

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