Data Entry Customer Service
Resume:
Irene Thompson
***************@*****.***
Skills: Pre – certifications, ICD codes, DRG, CPT Coding, data entry skills, electronic File, Intern, numeric number Customer Service Scanning, Indexing, Doc prep paper, Quality control, ability to handle multiple tasks and electronic File, documentation review, Mainframe
Education: William Penn High School Philadelphia, PA
Certifications
Alison training class for radiograph tech and medical imaging Radiology
Certified Pharmacy technician License board State of Illinois 2022 H&R block tax class in 2021
Harvard certification in Mechanical ventilation for Covid 19 Oct 2023 Harvard certification in Data analyst Sep 2023
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Experience:
Cotiviti / Claims Prod Analyst II / Benefit support / medical review Oct -2016- Present Blue Bell, PA
Benefit assistant, Claims processing tracking documents and payment of claims. Verify information in the system. Review medical records
Work on CPT coding, Modifiers, Codes, Anesthesia Codes, Surgery Codes, Radiology & Pathology/Laboratory Codes, Medicine Codes, HCPCS Code, Work with Well care, UHC, Aetna, electronic record specialist, Coventry medical charts. SNF regrouping claims, Input diagnosis codes and procedure codes make changes if needed for the codes Assist staff with Paid DRG codes. Work with. Work with Emblem health on facts. documentation review Amerigroup Facts, Aetna, BCBS_KC, and Health Now.
I used Health rules platform, system (CAPS ) for health plans
Import clients’ medical claims information from the paper into the system. Make Changes to the price of the medical record. Use medical ICD codes to be put into the grid. Attach new documents that have been changed to the MDS., Use JRAVEN, JIRVEN, JHAVEN regrouping the MDS, make changes to the Physical therapy, Occupation therapy, and Speech therapy.
PharMerica- Order entry Pharmacy Tech/ Filler Tech / customer service April 2022- OCT 2024 Horsham, PA
Claims Data entry, medical billing, fill prescriptions for customers medication prescription orders, restock shelves with new medication, print labels for orders, identify patient medication, dosage, and dispensing medication into the proper container, enter IV medication orders into the system crediting, and updating Prescription records, search for SIG codes, Prepacking medication, take calls, and transfer them to the right pharmacy, enter over 100 Prescription order a day. Changed NDC number, enter new patients’ info into the system. Check for allergies record
Enter data into computer system to fill prescriptions and to obtain reimbursement/payment, utilizing knowledge of drugs, medical nomenclature, and the metric system.
maintaining patient profiles, processing orders, verifying insurance, and ensuring accurate inventory.
Kelmar: Claims processor/ Property claim processor remote Jan 2024 to April 2024 Massachusetts, MA
Process claims for clients, verify client’s personal information, in the system, search for additional properties in the clients’ name. Transfer documents to the claim.
Verify if the claim is a Estate, business, or anything the client is calling in for. Make sure the payment goes to the right owner.
Catalent/ Medical Packing technician/ Production Aug 2023 to April- 2024 Philadelphia, PA
Preparing medical equipment and surgical instruments into boxes for use during clinical procedures or surgeries.
Pack and label syringes Package Medical supplies into packages to be shipped out. Work in a cold storage area like a freezer or fridge to package medication, label bottles, by hand. Examining supplies meticulously to ensure their cleanliness.
Help stage the rooms for the next medication to be processed and clean out the rooms once the job is complete.
Count labels, tamper seal. the boxes, Scan the packages into the computer. Clean medical equipment,
IBC/ Customer Service insurance Rep/ remote Feb -2021 – March 2023 Philadelphia, PA
Pre – certifications, medical claims, Data entry, answer customers question about their medical insurance plan, transfer calls to the right dept, look up providers NPI# on NPPES registry. Take inbound and calls help clients to log in to the system. Send out new medical cards to members. Look up Precertification for members and providers. Send out new or replacement medical cards to clients. Verify digital claims.
I used Health rules platform,
Used front office, Star CX, Health rules, Emdeon, MVP, Comprod Look up copays, benefits, medical policy, help clients find doctors, codes, codify codes. Transfer calls to level care and to different departments.
Talk to members about their tier 1, teir2, tier 3 benefits, help members with their cobra insurance. Submit EOBs, Document review, electronic record specialist. CPT Coding, Modifiers, Codes, Anesthesia Codes, Surgery Codes, Radiology Laboratory Codes, Medicine Codes, HCPCS Code, SAP
Contacting insurances (by phone and e-mail) for eligibility, benefits, network status and authorization, documenting information. Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
Follows up on delayed or denied authorization requests and escalates for resolution. Facilitate provider and insurance medical directors. reviews for medical determination if the visit should be authorized. Reviews and summarizes pre-authorization criteria for medical necessity to aid departments with procedure scheduling and/or financial advocate needs.
Pharma source / PHARMACY DATA ENTRY TECHNICIAN April 2022 – March 2023 Philadelphia, PA
Filled prescriptions and provided detailed instructions to patients to fulfill legal and safety requirements.
Worked with over 15 Pharmacy Technicians and staff to provide prescriptions and clinical services to patients.
Ensure Patients protect confidentiality according to the Health Insurance portability and Accountability Act
Data Entry, Refill patient prescriptions, made sure their prescriptions were for Qulipta input patients’ information into the system. Image indexing attach documents, RX prescriptions to patient profile. Customer service makes inbound and outbound calls to patients. Work on salesforce, citrix, five9, clear view software.
Vanguard/ Benefit support assistant/ Account maintenance, Remote June 2021 to Dec 2021 Malvern, PA
Benefit support assistant Answer Phone, handle clients 401k, Stocks, IRA, Brokerage accounts, retirement accounts, reset customers passwords, and update the clients phone numbers and address. Direct the calls to other departments. Send digital forms to customers to update their information quickly on the system. Check account balance for customers. Sign customers up for check writing.
Problem solving, Data Entry. Submit fraud report to the fraud dept for customer. SAP
Connolly I Health / Audit Support Assistant/ mail room June 2012- August 2015 Conshohocken, pa
Team leads Assistant of the investigation team. Take care of all missing medical claims and problems for customer service. Search for claims using the tracking number ICN numbers. Process all MR claims to the right patient. Create more than 300 CMS cover sheets a day to be scanned into the system. Train new employees.
Process Recons, and ALJ Hearing notice and Amended notice Data Entry, Numeric Numbers, Electronic Faxing .and electronically correctly and filing, scanning. Make excel sheets for missing patients in formation. MCR medical char review sort and prep the medical record, invoice, and the UB92 form each chart. Work with UHC, Aetna, Humana, Well Care, Coventry, Amerigroup, Excellus, BlueCross blue shield. Recons, Upload MCR and CMS CDs into the system. Update all Medical records for providers contact forms into the system. Train on HIPPA codes. Process Electric Medical records on
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