Customer Service Data Management
Resume:
Shimone Harris
*******.********@*****.***
Hiring Manager
Please consider the accompanying resume for the position currently available in your department. I am particularly interested in the position because it will allow me to utilize my data management and analytical skills as well as allow me the opportunity to demonstrate my expansive organizational skills.
My years of experience have armed me with outstanding leadership, organizational and customer service skills and I am the person that will supply that extra ten, fifteen, or even twenty percent needed to be successful in this position. I have consistently met requirements set by my past employers and I would like the opportunity to do the same for you.
I enclose my resume for your consideration and I would welcome the opportunity to further discuss your needs and my abilities. If you have questions or would like to schedule an interview, please contact me by phone at 314-***-**** or email *******.******@*****.***.
Thanks again for you time and consideration, I look forward to hearing from you,
Sincerely,
Shimone Harris
Shimone Harris
*******.********@*****.***
Objective:
I am an enthusiastic and reliable customer service professional. Within my seven years of work experience, I have developed the capability to multi-task, effectively communicate with management, peers, and clients, and sustain a professional work ethic. I am eager to secure a full time career with an established employer so that I can showcase my talents and thrive within the organization.
Professional Profile:
Government & commercial insurance knowledge
Insurance follow up & medical collections
Medical Terminology
Fair Trade Practices Act as it relates to claims
Negotitating claim settlements
Data entry 40wpm
Excellent verbal & written communication skills
HIPPA compliant
ICD-10 (9 credits earn)
CPCU coursework training
Professional Experience:
Cloudmed: March.2021- Current Claims Analsyt II
• Resolve hospital bills with workers’ compensation insurance plans
• Maintain timely and professional follow-up on account volume, primarily via phone
• Address and respond to denials from insurance companies to ensure accurate payment of submitted bills
• Prioritize inquiries from key stakeholders and assist with project-specific tasks and reporting
• Communicate regularly and effectively with key stakeholders and upper management
• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• Utilize Cloudmed and client software platforms to manage account information and workflow
• Follow Cloudmed’s privacy, security, and compliance policies, including adherence to HIPAA guidelines
• Analyze and solve problems while demonstrating sound decision making skills
• Process time sensitive data and information from multiple sources
• Handle claims to the line Claim Handling Standards
sources
Conifer Health Solutions: July. 2015- September.2019 Accounts Receivable Specialist
Requests additional information from Patients, Medical Records, and others upon request from payors.
Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed.
Updates Plan IDs and Patient/Payor demographic information; posts notes and memos to accounts; identify payor issues and trends; and solve recoup issues. Returns accounts to Appeal Writers for next level appeals as needed.
Identifies payor trends in payment delays and escalates issues to Supervisor.
Recognizes potential delays with payors such as corrective actions and responds avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and must be able to communicate results.
Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.
Conducts collection activity on previously appealed claims by contacting government agencies, third party payers via phone, email, or online. Provides ongoing appropriate collection activity on appeals until the payer has responded to the appeal.
Analyze and solve problems while demonstrating sound decision making skills
Process time sensitive data and information from multiple sources
Handle claims to the line Claim Handling Standards
The Outsource Group: Feb. 2014 – June 2015 Collection Representative
Performed follow up insurance billing & collection activities on claims
Worked an average of 25-30 claims per day
Called insurance companies & utilized payer websites to verify accuracy of claims
Resolved rejections & denials
Expedited payments from various payers for physician’s services
Followed up with insurance companies on denied/rejected claims
Reviewed patient EOB’s and took necessary collections actions
Taking inbound/outbound calls
Review patient accounts and update demographical and insurance information
US Bank: 2010 – 2013 Administrative Assistant
collected and interpreted data to produce reports; conducted special projects
coordinated meetings, conferences, presentations and travel arrangements.
composed correspondence and other documentation as needed. Frequently used personal computer software packages for word processing, graphs, spreadsheets, etc
World Omni: 2009 - 2010 Collections Representative
Responsible for collection on accounts 1-45 days delinquent
Skip tracing to located customers
Answering inbound/outbound calls on dialer system
Express Scripts: 2008 - 2009 Account Representative
Accountable for mailing prescriptions & assisted clients in collections
Answered inbound/outbound calls
Entered data for customer prescriptions
US Cellular Urban Media Group: 2006 – 2008 Team Leader/Sales Representative
Answered inbound calls
Responsible for individual executive of tact to achieve assigned quotas
Required to accurately complete all sales and service paperwork
Responsible for ensuring that the rules of the sales process are being followed
Education:
Beaumont High School, St. Louis, MO
High School diploma
Reference Available Upon Request
Contact this candidate