Data Entry Customer Service
Resume:
SherLonda L. Jones
**** ****** **. ***. ****, Murfreesboro, TN 37130-2792
***************@*****.***
CUSTOMER SERVICE & HEALTHCARE PROFESSIONAL
Achievements
Increased customer retention by 19%, from 72% to 91%.
Created customer satisfaction survey, drastically reducing potential problems.
Profile
More than 30 years’ successful experience in Customer Service, Data Entry, Healthcare and Call Center with recognized strengths in account maintenance, problem-solving, health insurance and troubleshooting. I’ve taken over 50 inbound and made some outbound calls for most of my assignments.
Possess solid computer skills, Comtrac, billing and creating accounts, mailroom experience.
Computer, troubleshooting, copy machine, fax machine, printer, Avaya, and Cisco phone system.
Excellent working knowledge using: Epic software, Microsoft Excel, WordPerfect, Microsoft Word, Microsoft Office 365, Outlook, Access, Power Point Microsoft Lync, Skype, Zoom, Webex, Teams, AS 400, Facets, Filenet, Citrix, Marx, Peoplesafe/Caresource, Epic system, Fazal, Medhok, Agent Portal, Safari, Typing and 10-Key. Salesforce, Medical Records, Medicaid, Medicare, Chips and Insurance, Billing and Coding
Past Jobs not on Resume: MS Legal Aid (InTake Specialist), Healthcare, MS Dept of Health Health Information System, STD, MS Dept of Human Services, Physician Scheduler for Dermatology with UMMC, ComCast, MTM Transportation, Volunteer Lease Consultant, InTake Coordinator and InTake Representative for Legal Services.
Knowledgeable Contract, Contingent worker with iPhone, iPod, iPad, and Apple computer. Ability to supervise and acknowledge HIPPA.
Employment
ICON Consultants (Contract)
St. Thomas Hospital July 2024-August 2024
R1 RCM
Picking up charts daily from the ER up to the 8th floor
Check the discharge records off the list of discharges and missing records
Pre-prep the charts, scan and QC each chart for billing
Employnet
Cupid (Ventura Chicago Transit) June 2023-February 2024
Customer Service Representative
• Created accounts, updated demographic information for the customer.
• Scheduled rides, added bus passes, troubleshooting their accounts so they’re able to ride the transit or the train and take payments for monthly passes
Apidel Technologies (Remote)
CVS September 2023-May 2024
Coverage Determination Representative
• Applied information provided through multiple channels to the plan criteria defined through work instruction.
• Conducted outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
• Escalated issues to Coverage Determinations and Appeals and management team as needed.
• Always maintained compliance with CMS and department standards.
• Utilized multiple software systems to complete Medicare appeals case reviews.
• Meeting or exceeding government mandated timelines.
Spectraforce (Remote)
Amerisource Bergen/LashGroup October 2023-February 2024
Patient Access Specialist Bristol Myers Squibb program
• Over 50 inbound and outbound calls
• Processing Cases
• Creating Profiles for new patients, checking status of applications, sending emails to expedite cases as well as escalating cases and generate General Inquiry and document the notes.
Conduent (Remote) June 2023-November 2023
Customer Care Support
• Over 50 inbound and outbound calls
• Assisting customers with their Health Savings Account and Flexible Savings Account, assisting them with how to get their claims and how to use their benefits before their expiration date.
• Advised them of their balance for the spending limits
Spectraforce (Remote)
LabCorp May 2023-June 2023
Pharmacy Coordinator
• Quickly and efficiently respond to incoming calls and faxes, identify how best to assist.
• Document calls in appropriate tracking systems, and handle/escalate calls per established procedures.
• Conduct insurance verifications to understand if patient’s prescribed therapy is eligible for coverage. Possibly coordinate prior authorizations, investigate alternative insurance coverage, or other funding sources on behalf of the patients per the program specifications.
• Process patient applications of various complexities and follow the programs specifications to determine their eligibility.
• Place follow up calls and respond to enquiries from patients and/or healthcare providers as necessary.
• Liaise with partner distributors and pharmaceutical manufacturers to request products per the program’s guidelines and track shipments.
• Coordinate the order and transfer of prescriptions based on their degrees of urgency to specialty pharmacies as appropriate.
• Be familiar with the marketplace and the insurance options available for patients.
• Educate patients on the available options as appropriate.
• Assist with training new team members by shadowing/reverse shadowing them and serving as a data checker by reviewing data entered in the program’s tracking system.
• Maintain a professional, calm, and friendly demeanor.
• Express thoughts and instructions clearly in both verbal and written communication, i.e., uses grammatically correct and concise language.
• Other duties as assigned.
Spectraforce (Remote)
AmeriSource Bergen/LashGroup September 2022-February 2023
Patient Account Specialist
The AR PAS team is a team of individuals who review renewal.
Enrollment forms to assess PAP Medicare Part D renewal eligibility for the AR 2022-2023 season. You as an AR-PAS will identify records that are missing information and appropriately update the record status of what information is needed. You will determine eligibility based on Medicare Part D PAP criteria as well as review enrollments forms and records to ensure data integrity.
a) Updating demographic information in patient records
b) MedConnect/CenterX
c) RTIPS
d) Rolling RSL and PAP trees
e) EBifs, PSQA Notes
f) Faxing to MDO and Printing to Patients
Zillion Technologies (Remote)
Highmark Healthcare April 2022-June 2022
Customer Service Intake Coordinator
a) working records from fax
b) entering triage information
Spectraforce (Remote)
AmeriSource Bergen/LashGroup November 2021-March 2022
Benefits Verification Specialist/Patient Service Representative
a) Billing and coding support
b) Claims assistance, tracking and submission
c) Prior authorization assistance and tracking
d) Coordination of benefits
e) Benefit verification result call
f) Welcome calls
g) Advanced alternate coverage research
h) Appeals/Denials
i) Intakes and reports adverse events as directed
1. Reviews all patient insurance information needed to complete the benefit verification process.
2. Triages cases with missing information to appropriate program associate.
3. Verifies patient specific benefits and precisely documents specifics for various payer plans including
patient coverage, cost share, and access/provider options.
4. Identifies any restrictions and details on how to expedite patient access.
5. Could include documenting and initiating prior authorization process, claims appeal, etc.
6. Completes quality review of work as part of finalizing product.
7. Reports any reimbursement trends/delays to management.
8. Performs related duties and special projects as assigned.
Jackson Police Dept. Records August 2018-June 2021
Crime Analysis/Data Entry
Assist with keying in reports that are brought into the office, answer phones, scanning, typing reports and file.
Former Dispatcher
Actively listen and probe callers in a professional and timely manner to determine the purpose of the calls. Research and articulately communicate information to callers while maintaining confidentiality.
Comprehensively assemble and enter members and providers8 information into the appropriate system to initiate the requested transportation services. Perform necessary follow-up tasks to ensure member or provider’s needs are completely met.
Education
Hinds Community College 1989-1991 Utica, MS
Bu Business Administration
References Furnished Upon Request
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