Customer Service Care Representative

MICHELE BROOKS CPC-A

● Chesapeake, VA ● ***** ● 757-***-**** ● **********@*****.***

SUMMARY OF QUALIFICATIONS

Results oriented with demonstrated accomplishments in the medical field, Lead focus groups to improve productivity and morale. Recognized and awarded for exceptional collaboration and team members and customer satisfaction.

Expertise includes: ICD-10, CPT codes, Medical claims, billing, processing, reconciliation, claims follow-up and appeals. Proficient in Microsoft Office Suite, 45 WPM, Commercial, Medicaid, and Medical Insurance and various Government payers. Amysis, Maces, Mysis, CPC, SharePoint, Outstanding Customer Service, Medical Coding, CCERT. Innovative and consistently rewarded by management for providing top-notch technical, quality and production. Identify root cause analysis and corrective action implementation. PROFESSIONAL EXPERIENCE

Sentara Medical Group Norfolk, VA

AR Specialist 2 08/2020-Present

• Accountable for daily operational tasks associated with revenue cycle accounts receivable.

• Responsible for claims follow-up, timely and effectively managing requests from patients, insurance primary, secondary, and tertiary payers for filing purposes.

• Clear hours, and prepares all appeals and resolves all upfront edits and denials.

• Routinely monitors and processes monthly write-offs, charge corrections and reconciliation of claim files for assigned area of responsibility.

Anthem, Inc. Norfolk, VA

Financial Operations Recovery Specialist I 09/2015-July 2020

• Promoted from Financial Operations Recovery Specialist to Specialist I.

• Promoted from Customer Care Representative to Financial Operations Specialist within 18 months.

• Successfully processed claims overpayments and reimbursements resulting in reconciled statements.

• Conducted and analyzed complex claims research and resolution of projects involving overpayment.

• Investigated and determined reason for overpayment and other party disputes.

• Adjusted claims in Facets based on refund received and resolution of disputes.

• Resolved claims and over payment issues in various lines of business for Anthem. Chesapeake General Hospital Chesapeake, VA

Medicare & Commercial Care Representative 04/2014-09/2015

• Coordinated all patient and insurance billings for the medical facility.

• Provided outstanding customer service and maintained effective communication with team members.

• Recorded payments in the system, adjusted billing according to billing and payment policies.

• Submitted claims, electronically and manual for insurance invoices and to followed up for records.

• Monitored accounts and followed-up unprocessed and unpaid claims for resolutions.

• Recorded payments in the system, adjusted billing according to billing and payment policies.

• Understood and used the department computer system in an effective and proficient manner. Wellpoint (BlueCross BlueShield Mason,

OH Customer Care Representative 05/2013-

04/2014

• Researched and resolved Medicare claims and benefits for provider contracts, eligibility, and claims.

• Analyzed problems and provided information and solutions.

• Input information using Facets operating system to obtain information and changes in the database.

• Built rapport with customers to maintain outstanding customer service. Amerigroup Corporation Virginia Beach,

VA Claims Analyst II 09/2002-

06/2011

• Promoted to 4 positions within 18 months of service.

• Processed adjustments and claims accurately and followed all medica policies and procedures.

• Reviewed, analyzed, and processed claims and policies to determine company’s liability.

• Supported team members with special projects and covering shifts.

• Provided outstanding customer service, followed with customer satisfaction for satisfaction. EDUCATION

Norfolk State University- CPC Certification Received June 2016

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