Customer Service Data Entry

Gail House

Houston, TX ***** 832-***-**** ****.********@*****.***

Professional Summary

Customer service professional with extensive experience in a managed healthcare environment, specializing in reconsideration and claims resolution. Proven ability to navigate complex healthcare policies, advocate for patients, and ensure compliance with industry regulations. Strong interpersonal skills, problem-solving abilities, and a commitment to delivering high quality service in fast-paced environments.

Core competencies include customer support, conflict resolution & negotiation, HIPAA & Regulatory compliance, electronic health records, Microsoft Office/Excel, contracts, team support / Ad-Hoc, planning & organizing.

Professional Experience

Medical Bill Coordinator 09/2019 to Current

Sedgwick, LLC

• Managed reconsideration requests for denied claims, ensuring fair and accurate reassessment in compliance with healthcare policies.

•Provided expert-level customer service, assisting patients and providers with claim disputes and appeals.

•Investigated and resolved escalated issues by coordinating with internal teams, insurance providers, and healthcare professionals.

•Maintained detailed records of appeals and reconsideration cases, ensuring accurate documentation and compliance with HIPAA regulations.

•Communicated resolution to appropriate parties.

•Increased customer satisfaction by resolving grievance/appeals. Lowering grievance/appeal ratio to 40% within the first quarter.

•Use company troubleshooting resolution tree to evaluate technical problems while leveraging personal expertise to find appropriate solutions.

Data Management 5/2012 - 9/2019

Rockport Healthcare Group

•Verified and corrected discrepancies in provider data, improving data accuracy by 50% within the first quarter.

•Entered PPO provider contracts into Access 97 system with an accuracy rate of 90%.

•Effectively handled urgent data entry requests, ensuring a turnaround time of under 24 hours for high-priority tasks.

•Executed data entry tasks 40% faster than team average.

Front Office Receptionist 3/2006 - 5/2012

Rockport Healthcare Group

Greeted visitors, answered phones, and directed inquiries to the appropriate staff member.

Maintained a professional and friendly atmosphere in the reception area.

Effectively managed incoming and outgoing mail and packages.

Scheduled and coordinated meetings and appointments.

Assisted with administrative tasks such as filing, photocopying and scanning.

Crossed trained with other departments as needed.

Assisted with special projects as needed.

Collected customer feedback and made process changes to exceed customer satisfaction goals to 60%.

Education

Bachelor of Science: Health Administration

University of Phoenix - Tempe, AZ

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