PAMELA GLAUDE

**** * *** ***, **********, OK ****4 209-***-**** adym7z@r.postjobfree.com

Professional Summary: I am interested in a remote Customer Service opportunity where I can utilize my skills in billing and claims as well as in customer service.

Skills:

•Medical Record Review

•Order Administration

•Customer Service

•Collections, Billing, and Benefits

•60WPM

•Answered high volume of inbound and outbound phone calls

•Softheon, CMT, EPP Electronic Payment

•Proficient with ICD-10, Medicaid, CPT Coding, ITeams, Zoom, Microsoft Office, Outlook, Excel, PowerPoint

•In-depth experience with medical claims, outreach, care coordination

• Skilled in Avaya, Sale force, C+, SAP, QBat, CMS,

EPIC, Chart Finder, Cerner, Epic, NextGen, Facets

Work History:

•

During this period, I worked in various contract positions: customer service agent, billing clerk, data entry, for various staffing agencies.

Care Coordinator

CVS CareMark- Phoenix AZ

(Contractor)

•Utilized software to assist with prior authorizations.

•Liaison between patients and providers, providing.

•excellent customer service

•Provided support for Pharmacist.

•Researched billing issues

•Performed medical record reviews when necessary

07/2020 to 12/2022

01/2020 to 06/2020

Customer Care Specialist 07/2019 to 12/2019

CenturyLink-Phoenix AZ

•Managed high volume of incoming phone calls. Managed 50 + customer calls per day.

•Collection of payments resolved billing disputes.

•Supported various departments in multiple administrative tasks.

•Goal setting and forecasting accomplished in sales of new products to customers.

•De-escalated customer issues with proven conflict mediation, problem-solving abilities

•Delivered fast, friendly, and knowledgeable service for routine questions and service complaints.

Care Specialist 11/2018 to 05/2019

Cognizant Tech Solutions – Phoenix, AZ

(Contractor)

•Monitored multiple databases to keep track of all patients’ inquiries.

•inbound call contact center, patient care coordination, communicate plan changes with clients, in bound Medicare CSR

•Customer Service, data research for client and verifying accounts are correct regarding health plans and patients' information.

•Directed to appropriate departments, data entry, compiling reports for supervisors.

•Verified medical records, responsible for maintaining compliance with CMS regarding client specific requirements.

•Worked as part of team to meet business unit objectives, documentation of client's requests and resolution of requests.

•Verified claim status, verified eligibility and benefits, verified clients' payments and premiums, assisted clients with payments and billing issues.

ROI Analyst 04/2018 to 09/2018

Ciox Health Inc – Phoenix, AZ (Contractor)

•Requested Release of Information through various hospitals portals

•Requested patient's medical records, provided copies of both paper and electronic records to insurance companies, providers, and health plans upon request.

•Documented requests, verified prior authorizations, identified patients and any restrictions of patient information.

•Supported various departments during HEDIS season, as well as certificated In HEDIS Compliances,

•HIPAA, Medicare Parts C and D General Compliance

•Monitored multiple databases to keep track of patient and provider information.

Education:

High School Diploma: Business and Accounting

Ohlone College - Fremont, CA

Additional Information

• Additional Information AWARDS, Received Special Recognition Award for significantly reducing past due revenue, President Club 2000, and President Club 2001

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