Customer Service Workers Compensation

DOMONIQUE S. FLETCHER

**** ****** **** ***** 769-***-****

Pearl, MS 39208 *********.********@**.***

SUMMARY OF QUALIFICATIONS:

Ten + years of experience in the health care insurance industry, including experience with Workers Compensation claims. Responsible for maintaining confidentiality of information. Extremely knowledgeable of Medical Coding guidelines (ICD-9). Strong knowledge of Centers for Medicare & Medicaid Services (CMS). Ability to process new claims and disseminate claims to the appropriate insurance carrier while adhering to HIPPA guidelines.

• Exceptional customer service

• Detail oriented quick learner

• Ability to solve problems

• Type 65+WPM

WORK EXPERIENCE:

Department of Veterans Affairs

11 Riverbend Place

Flowood, MS. 39232

Advanced Medical Support Assistant Jan 2020- Present

• Schedule veteran’s appointments and consultants at various clinics and services

• Receive telephone calls from veterans. Make and cancel appointments

• Obtain data from various forms and enter data into automated data system

• Make determinations as to the eligibility for the type of care veterans has received

• Create authorization for veteran’s medical care

• Familiar with Electronic Wait List

• Utilize various electronic data processing system to input data for processing claims and generating automated correspondence

Medical Support Assistant Mar 2018- Jan 2020

• Meet and greet veterans and verifies eligibility for care.

• Explain benefit program and entitlement criteria, identify issues, gathers relevant evidence and input data necessary to generate the award and notification letter to the veterans Department of Veterans Affairs

100 Spring Lake Cove

Pearl, MS 39208

Voucher Examiner Nov 2015 – Mar 2018

• Prepare statements, reports and schedules to reflect accuracy or data and discrepancies

• Acquires and maintains computer literacy and knowledge of all computer packages which are used to support patient care and required to perform duties

• Navigate and research questions and documents with minimum supervision

• Responsible for maintaining confidentiality of information obtained to carryout required duties RevClaims, LLC (Medical billing service) Dec 2014 – Jan 2016 2510 Lakeland Terrace

Jackson, MS 39216

Resume of Domonique S. Fletcher p. 2 of 2

Workers Compensation

• Audit total charges on the UB-04 and HCFA 1500 claim form for workers compensation

• Reviews and analyzes claims loss and expenses reserves established by insurance carriers

• Acts as liaison between the insurance carriers and insurance broker to maintain loss expense reserves that are reflective of the company’s exposure

• Processes new claims and disseminates the claims to the appropriate insurance carrier

• Extremely knowledgeable of Medical Coding Guidelines and coding techniques (ICD-9)

• Strong knowledge of Centers for Medicare & Medicaid Services fee schedule and Diagnosis Related Group

• Adhere to HIPAA Guidelines for patient accounts

• Verify W-9’s for hospitals

Entergy Dec 2013 – Aug 2014

410 S Jefferson St

Jackson, MS 39201

Customer Service Representative

• Handled inbound customer calls and e-mail for assigned customers, providing a single point of contact for the specific transaction or issue

• Acted as the single point of contact for assigned Entergy’s members in order to facilitate and/or expedite interactions within the company

• Initiated customer contact to ensure satisfaction with service provided

• Thoroughly research assigned ticket issues and take appropriate action to resolve and meet turnaround time requirements and quality standard

Universal Health Care

385B Highland Colony Pkwy Ste 405

Ridgeland, MS 39157

Quality Analyst July 2011 – Mar 2013

• Monitored, evaluated and scored inbound and outbound calls against established quality assurance instruments and standards

• Prepared reports and analysis form quality assurance data and communicates performances trends to management

• Partnered with training to share performance data drawn from quality monitoring and review and identify potential training needs

• Assisted in the preparation to call scripts and recording assuring adherence to and approval as required from government and internal regulatory and compliance function Member Service Representative Aug 2010 – July 2011

• Handled inbound customer calls and e-mail for assigned customers, providing a single point of contact for the specific transaction or issue

• Acted as the single point of contact for assigned Universal Health Care’s members in order to facilitate and/or expedite interactions within the company

• Participates in the creation of acquisition strategies to acquire and purchase DME

• Providing guidance and consultation to clients in regards to insurance and health benefits

• Initiate customer contact to ensure satisfaction with service provide EDUCATION:

University of Phoenix Completed 32 credit hours toward Business degree GPA: 3.2 of a maximum 4.0

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