Customer Service Data Entry

Jenette Torres

Customer Service Specialist

Justin, TX 76247

*************@*****.***

+1-214-***-****

Professional Summary

Bilingual English and Spanish, Customer Service, Call Center, Clinical Receptionist, Pharmaceutical Medical Terminology, well developed, creative with Leadership and teamwork skills Willing to relocate to: Dallas, TX - Lewisville, TX Authorized to work in the US for any employer

Work Experience

Billing Specialist

North Dallas Eye Associates-Lewisville, TX

August 2022 to Present

Responsible for submitting claims and following up with insurance companies. Posting and managing account payments. Data entry of charges and billing of claims to different insurance companies. Medical AR follow-up procedures to include reviewing and working aging reports, denials and insurance correspondence from the insurance carriers. Audit and analyze patients accounts. Learn new customized software quickly Payment posting and account reconciliation Review. Process adjustments and refunds on patient accounts.

Medical Billing Specialist

Advanced Rx Management-Tampa, FL

August 2021 to July 2022

• Post insurance payoff EOR’s and attorney’s payments, making accurate adjustments

• Follow up on claims rejections

• Entering accurate information such as modifiers, ICD10, and Worker’s Compensation Claim numbers

• Submit insurance claims electronically or via HCFA 1500 form

• Appeal claims

Insurance Collector

Blackstone Medical Services-Tampa, FL

April 2020 to August 2021

• Follow up on outstanding insurance claims.

• Appeal denials

• Work with insurance companies to get claims paid.

• Work accounts receivable to get unpaid balances.

• Coordinate with finance area to get benefit verification efficiently.

• Receive and post payments to patient accounts daily.

• Follow-up to ensure timely resolution of appeals, re-billing's, obtain updated insurance information.

• Apply knowledge of third party payer guidelines in reviewing denied claims

• Correct insurance information on rejected insurance claims and resubmit for processing Pharmacy Coordinator

Max health-Sarasota, FL

September 2018 to April 2020

• Support the medical team department coordinating services.

• Receive and respond to providers and pharmacy calls regarding prior authorizations

• Assist with patients inquires related to prescription process

• Assist with the pharmacy utilization review and reporting process

• Assist provider relations department with educating providers on the health plan’s pharmacy process.

• Pharmacy administration opening, closing inventory including cash registers.

• Prescription processing by Rx30 system, fill and mail medications.

• Approval and denials of Rx request from pharmacies CNA/CMA

Cardiovascular and Vein Center of Florida-Bradenton, FL March 2016 to September 2018

• Greet Patients

• Vital Intake

• Data Entry

• INR Checking

• EKG

• Medical Records

• Stockings measurements

• Scheduling

Customer Service Specialist - Call Center

Abarca Health-Hato Rey, PR

September 2013 to May 2015

• Answered questions to pharmacies health insurance and beneficiaries

• Recommended corrective services to address customer complaints, payment status, manual reversal requests, benefit/eligibility support, provider portal support and response to price appeals.

• Rejection support including overrides.

• Documented Prior Authorizations request inquiries, issues, status and resolution. Pharmacy Technician

San Justo Pharmacy-Saint Just, PR

January 2013 to May 2015

• Customer service

• Supervise staff

• Daily reports

• Answer telephones

• Address questions or requests

• Data entry

• Managed cash register

• Inventory

Pharmacy Technician

Puerta de Carolina Pharmacy-Carolina, PR

November 2002 to December 2011

• Customer Service

• Call center

• Create customer profile

• Control substances inventory

• Prescription

• Managed cash registers

Education

Bachelor of Science in Nursing

Central Arizona College - Tampa, FL

March 2021 to Present

Bachelor's degree in Nursing

Universidad Del Turabo - Florida

March 2018 to January 2021

Pharmacy Technician

Centro de Estudios Multidiciplinarios

2001 to 2003

Skills

• Medical Records

• Customer service

• EMR

• ICD-9

• Anatomy Knowledge

• ICD Coding

• Documentation review

• Supervising Experience

• Triage

• Physiology Knowledge

• Medical Coding

• Intake

• Medication Administration

• Vital Signs

• CPT Coding

• ICD-10

• Quality Assurance

• Phone Etiquette

• Pharmacy Technician Experience

• HIPAA

• Nursing

• Case management

• Medical Scheduling

• Spanish

• Experience Administering Injections

• Medical Billing

• Medical Terminology

• Prior Authorization

• EKG

• Administrative experience

• Medical Office Experience

• Insurance Verification

• Microsoft Word

• Patient Care

• Microsoft Excel (5 years)

Links

http://*************@*****.***

Contact this candidate