Customer Service Case Management
Resume:
Frankie K. Banks
Columbus, GA **904
***********@*****.***
QUALIFICATION SUMMARY
•19+ years of advanced knowledge of technical healthcare processes.
•Independently managed 2 health services clinics from first interview, contacting past employers to the training process and assigning work.
•Ability to communicate tactfully and effectively in writhing and orally to patients and various organizational levels
•Prepare/compile reports in various formats to present data to various organizational levels
•Ability to utilize reference sources and empower the team to collaborate, set priorities and resolve problems within a complex system environment, maintaining patient complaint logs with resolutions
•Patient Advocate/Case Management worked daily with patients on transportation; attending appointment; explain physicians’ findings; contacted family members and went over visits as needed; coming up with a plan that allows the patients to function more independent and have a better emotional and psychological outlook on the current status of what is going on.
•Advanced knowledge of policies and procedures associated with verifying codes and amounts, scheduling surgery, collecting pre-payment and billing charges, maintaining monthly meetings to update group as needed
•Exceptional administrative skills with the ability to type over 70 words per minute; attend meetings and provide minutes of prior meetings
•Advanced knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) International Classification of Diseases (ICD-9, ICD-10) coding
•Professional Paper Claim form (CMS-1500) and Hospital Claim form (UB-04) billing experience
•Advanced knowledge of Healthcare Information Portability and Accountability Act (HIPAA) compliance and regulations.
•Advanced knowledge of the technical health care process and medical terminology as it relates to the complex nature of language used by clinicians.
EDUCATION
Miller-Motte College – Wilmington, NC Graduation Date: April, 2016 Bachelors of Science in Allied Health Management Cumulative GPA: 3.93
Related Coursework: Healthcare Organization and Administration, Planning and Evaluation, Healthcare Finance, Human Resources Management, Healthcare Law and Legislation, Managed Care and Insurance, Health Education, Management Information Systems, Principles of Public Policy and Administration, Accounting Principles
Miller-Motte College – Wilmington, NC Graduation Date: December 2013
Associates of Applied Science in Electronic Medical Records GPA 3.83
CERTIFICATION
Georgia Certified Patient Account Representative (CPAR)
Community Emergency Response Training (CERT)
Working on Certified Revenue Cycle Representative (CRCR) certification
EXPERIENCE
Denials Revenue Specialist/Professional Biller June 12, 2023, to Current
Healthrise—Remote
Responsible for multi daily WQ’s to include but not limited to: No Response, Denials, Rejections and Recoupments
Training of new employees
Daily answers to questions of other team members through Teams chat
Working on Special Projects with Manager on day-to-day basis as needed
Maintaining 60 plus worked accounts on a daily basis
Working from 2 emails on customer service questions and other questions from different departments as needed
Working day to day with Offshore team answering questions and providing solutions to problem accounts.
Verified insurance through web portals
Checked claims status through clearing house identifying problem issues and also through web portal for processing and payment information
Revenue Recovery Specialist February 2022-January 2023
Knowtion Health—Remote
Verify Insurance and patient demographical information on patient accounts daily to answer questions on charges, benefits, and negotiate discounts
Corrected and rebilled claims to various payers
Added insurance to include Medicare, Medicaid and Commercial Payers
3-way calls with Patient and Insurance Carrier to update needed info to get claims processed
Participated in weekly and month team meetings
Helped with the answering of questions for other team members
Provided quality customer service to all patients and insurance carriers
Customer Service Rep 1/Remote
Anthem BlueCross Blue Shield July 2021 to February 2022
Answer inbound calls for benefits and eligibility
Provided exceptional customer service
Forward calls to correct departments when not handled in our area
Maintain professionalism with all calls
Medical Secretary/Reimbursement Analyst Sep 2009 – Feb2021
Hughston Clinic, PC – Columbus, GA
•Verify Insurance and patient demographical information on patient accounts daily to answer questions on charges, benefits, and negotiate discounts.
•Collect co-pays, make payment arrangements, and exercise collection efforts on past due accounts in compliance with company policy.
•Review dictation and operative reports adding or correcting diagnosis codes when needed to get claims processed and paid, appealing unpaid charges when necessary.
•Review all unpaid claims for assigned physicians to include Physical Therapy, DME, and Workers Compensation; attaching notes when needed and submitting / resubmitting denied claims.
•Correct adjustments and move money between accounts to correct billing errors when needed.
•Train new employees in all aspects of the job at main location as well as satellite facilities.
•Participate in team huddles to manage and plan the best patient care possible.
•Provide the best customer service possible by developing and maintaining an effective and efficient relationship with the patient and any qualified family members.
•Routinely prepared reports and presented data to organizational level management
Satellite Office Manager May 2008 – Jul 2009
Family Healthcare – Columbus, GA
•Scheduled patients reviewed insurance benefits with patient and received co-pays.
•Billed and followed up on insurance claims; appealed on non-covered charges when needed.
•Processed monthly patient statements.
•Patient Advocate/Case Management helping patients with transportation; understanding bills and attending visits and explaining physicians’ findings
•Handled daily bank deposits and monthly statement reconciliation.
•Processed all AR/AP and payroll for entire office.
•Reviewed and renewed contracts with insurance companies (credentialing).
•Maintained general ledger and prepared monthly financials for accountant.
•Negotiated office equipment contracts and purchased supplies.
Data Entry Jan 2007 – May 2008
Columbus Clinic – Columbus, GA
•Retrieved and posted electronic payments for personal and insurance accounts.
•Reviewed EOB’s (Explanation of Benefits) and checked percentage of adjustments and ensured the correct reimbursements were paid.
•Composed spreadsheets for tracking of transactions.
•Trained new employees and set them up for success.
Merchandiser/Team Lead Apr 2006 – Jan 2007
Store Cast – Atlanta, GA
•Traveled to various businesses and locations to reset store shelves based on planograms.
•Composed spreadsheets of assignments completed, identified and corrected discrepancies in financial reports, reconciled mileage and hours weekly.
•Managed a team of 4 to 6 people keeping daily hours worked along with one-on-one relationships with store Mangers of reset locations.
Cash Poster Nov 2004 – Dec 2005
St. Francis Hospital – Columbus, GA
•Posted payments and adjustments from patients and insurance companies, separating according to insurance /workers comp.
•Worked directly with the finance department to make sure all payments received were accounted for on daily deposit.
•Reconciled accounts for daily and monthly reports.
Office Manager May 2003 – Jul 2004
JMH Medical Services – Smiths Station, AL
•Supervised employees both on and off site and the daily operations of Physicians office.
•Cross trained employees to improve overall office proficiency.
•Patient Advocate: arranged transportation, went over billing and attended appointments to explain the physicians findings. Also call family members and update them when needed.
•Handled for AR/AP, payroll, bank deposits and reconciliation.
•Reviewed insurance claims to ensure proper coding, processing and payment posting.
•Responsible for all billing to include electronic claims.
•Organized meetings with physician and staff to discuss office issues and goals.
•Prepared financial information and documents for Accountant.
•Handled all HR issues to include; hiring, terminations; vacations, sick leave, company insurance issues and clothing allowances.
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