Customer Service Representative
Resume:
Nicole Hudson
Experienced and Proficient Customer Service Representative
Little Falls, NY 13365
************@*****.***
Dynamic professional with diverse employment history, an uncanny ability to meet
company objectives and superb work ethic, seeking career growth and opportunities in the healthcare industry or customer service industry.
Strategic problem-solver providing creative solutions to an array of problems.
Quickly learns new skills valuable in a fast-paced technical environment.
Establishes working relationships and capable of motivating others to meet and exceed performance standards.
Highly skilled and analytical professional with proven over 20 years of Healthcare background particularly Medicare, Medicaid and other commercial health insurances.
Experienced professional with extensive experience processing health care disputes involving both Part A and Part B Medicare services.
Knowledge of Medicare law, regulations, national and local coverage rules• Experienced in medical terminology, ICD- and CPT interpretation.
Excellent communication skills with the ability to establish good rapport with
clients.
Highly resourceful; possess outstanding time management skills and an ability to multitask in fast-paced, pressure-filled environments
Authorized to work in the US for any employer
Work Experience
Medical Business Associates
May 2023 to June 2023 contract ended
PRIMARY RESPONSIBILITIES
Greets each patient as they enter the practice in a professional, caring manner and is warm in welcoming patients and vendors.
Performs patient check-in/check-out process with all patients. Reviews patient chart to determine what registration information is needed from the patient at time of check-in. Ensures patient records are accurate and up-to-date including patient name, address, date of injury, payer information, etc. by verifying existing information or entering updated data into the computer system.
Schedules and reschedules office and surgery appointments as necessary.
Address basic billing questions and redirect as appropriate.
Collects copays and outstanding balances at the time of service. Performs daily payment reconciliation.
Performs appointment reconciliation at the end of the day.
Answers incoming internal and external calls.
Utilizes electronic health record for messaging to/from clinical staff.
Enters patient information into practice management system from faxed referrals, phone or email and schedules appointments per clinical protocol.
Confirms pre-authorization is on file prior to patient’s arrival when required by insurance.
Manages incoming faxes and other documents including but not limited to disability forms, referrals, and medical record requests.
Scans medical documentation and other required documents into electronic health record or other document imaging system(s).
Performs insurance verification as appropriate to ensure accurate billing to appropriate insurance for patient encounter(s).
Maintains open communication with clinical staff to minimize interruptions to the providers’ schedules.
Attends meetings, as assigned, and participates in educational activities to keep skills up to date.
Upholds EMG policies, processes and procedures
Maintains open communication with clinical staff to minimize interruptions to the providers’ schedules.
Performs other duties necessary to maintain the overall efficiency and continuity of the clinic.
Is proactive in identifying, reporting and participating in the resolution of any potential or actual patient safety issues.
Patient Access Representative
Accredo Specialty Pharmacy for Cigna - Remote
September 2022 to February 2023
Contract ended
Responsibilities:
The Grievance team manages Medicare/Medicaid grievances that are presented by our members or their representatives pertaining to the authorization of or delivery of clinical and non-clinical services.
•Grievance works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner.
•Grievances coordinator position is focused on the processing of Medicare customer grievances.
•This associate may screen incoming complaints received orally or in writing, conducting root cause analysis as needed, creating an action plan, coordinating and communicating resolutions, as well as documenting systems in detail with case notes related to Customer grievances with in CMS guidelines.
•Grievance Coordinator is responsible for corresponding with members, providers and regulators regarding decisions and actions.
•Works collaboratively with the Claims, Customer Service, Appeals, and Medical Management Departments.
•Communicate, collaborate and cooperates with internal and external business partners.
•Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations.
•Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
•Supports department-based goals which contribute to the success of the organization
•Delivers straightforward administrative and/or other basic business services in Customer Service.
•Receives requests by telephone regarding insurance claims/policies.
•Responds to inquiries from policy holders, providers and/or others for information and assistance.
•Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
•Position typically requires excellent interpersonal skills, ability to understand and interpret policy provisions.
•Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
•Issues tend to be routine in nature.
•Good knowledge and understanding of Customer Service and business/operating processes and procedures.
•Works to clearly defined procedures under close supervision.
• Assist patients with billing and copay assistance for their rx through Accredo
Specialty Pharmacy.
•Create tasks to add / delete insurance information.
•Create Adverse Affect task when pts had ill affects to their medications.
•Add copay assistance plans to accts.
•Income and outgoing calls to assist patients with their ordering needs.
•Greet patients with a positive and professional attitude.
•Place outbound calls to current and former patients for the purpose of
scheduling follow-ups regarding bills and shipments.
•Collect patient intake forms and maintain patient files/notes.
•Schedule/Confirm patient appointments.
•
Complete benefit checks and authorization for each patients’ insurance.
•
a
Provide first level support to patients, answer questions, check patients in/out, nd collect and process payments.
General sales knowledge for accessories and any patient support.
· Other duties as assigned
Claim Specialist
eSolutions, Inc. For Optum Health care - Remote
January 2022 to May 2022
Contract ended
•Provide quick, efficient information
•Handle a high volume of inbound calls with varying degrees of questions and/or concerns and act as the primary customer service agent in processing or responding to basic customer requests, inquiries and/or bookings changes, and scheduling patients appointments.
•Performs this by achieving productivity standards and goals set by the company while maintaining a high level of customer service inclusive of total number of
incoming calls, length of call, and ACW (after call work).
Customer Service Representative
AAA Northeast - Remote
September 2021 to January 2022
• Assist members With roadside assistant calls.
•
Provide quick and efficient roadside service.
•
Assist members with benefit and enrollment .
•
Take payments in regards to enrollments
DME Coordinator/Medical & Dental insurance
Slavin, Jackson and Burns- Comprehensive Dentistry - Utica, NY
April 2016 to February 2021
DME Billing Coordinator & Dental
Receptionist
Claim Specialist for Medical and Dental Office
Job Responsibilities:
•Medical billing for Durable Medical Equipment for Sleep Apnea and Dental • Receptionist
•Skills used answer calls/make calls from patient and
•Contact insurance company to obtain missing information, explain and resolve claim denials and arrange for payment or adjustment processing on behalf of client
•Follow up on claims in a timely fashion as outlined in company and/or
departmental policies and procedures
•Research commercial and governmental payor policies and other documentation related to claims payment to evaluate and resolve open insurance balance claims
•Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
•Review insurance contracts to gain thorough understanding of payment methodologies
•Document information in appropriate company and client systems
•Prepare and submit correspondence such as letters, emails, faxes, online inquiries,
appeals, adjustments, reports and payment posting
•Contact patients/guardians to obtain information needed by insurance companies to process claims
•Maintain regular contact with necessary parties regarding claims status including payors, patients, clients, managers.
• Communicate with client contact concerning all issues related to billing, posting,
contracts and all other client related issues, both in an informal manner through daily contact and formal manner through scheduled while maintaining a
professional attitude and approach with all payors strong, lasting relationships with
clients, payors and personnel
•Support and direct claims to all departments and client onsite analysts
•Attend client, department and company meetings
•Comply with federal and state laws, company and department policies and procedures.
•Prepare bank deposits and submit daily reports to finance
•Process patient orders, receive all orders and verify pick up, input information into
system.
• Clean and maintain equipment and instruments.
• Submit equipment and facility requests.
•General office duties, including cleaning.
•Manage inventory, order/monitor stock, and submit supply orders as needed.
• Assist with event planning and logistics for at least 1 community outreach event per month
Accounting Clerk
MetLife - Oriskany, NY
February 2016 to April 2016
Claims Specialist
Job Responsibilities:
I process payments to Tricare Dental accounts.
Underwriting Dept.
Excellus BlueCross BlueShield - Utica, NY
November 2015 to January 2016
Job Responsibilities:
• Analyze financial data evaluate degree of financial risk follow contract, property, or
insurance laws gather relevant financial data identify financial risks to company
make decisions review data on insurance applications or policies use computers to enter access and retrieve financial data write business correspondence
Advocacy Associate
Excellus Blue Cross Blue Shield - Utica, NY
May 2015 to September 2015
Contract ended
Claim Specialist
Job Responsibilities:
•Answered incoming and placed outgoing calls to account holders and physicians regarding claims submitted for processing.
•Communicated with physicians, other healthcare professionals and contributed to the development and maintenance of health information networks.
•Made reconsideration determinations on Medicare appeals
•Reviewed cases to determine the facts of each case and assesses issues involved in the case.
•Reviewed files to determine whether all relevant information has been submitted.
•Identified and matched denied item(s) within the case file, the denial rationale presented by the Medicare contractor and arguments of appellants.
•Correctly matched denied items and arguments to Medicare policies.
•Used Internet and hard copy tools to research issues using federal laws and
regulations relevant to CMS policies.
• Responsibilities include claims adjustments and written or oral communication to management, provider or Medical Directors
Home Health Aide
Independent Care - Rome, NY
April 2014 to September 2015
Home Health Aid (part time)
•Provide care to patients
•Follow doctor's order for treatments and administered medication
•Monitor vitals and noted any behavioral changes or new symptoms.
• Help patients maintain independent living with personal care assistance.
•Support patients with customized patient teaching tools.
•Manage patient schedule
Health Representative
MetLife
July 2014 to February 2015
Claim Specialist
Job Responsibilities:
• Answered incoming and placed outgoing calls to account holders and physicians
regarding claims submitted for processing.
•Communicated with physicians, other healthcare professionals and contributed to the development and maintenance of health information networks.
•Made reconsideration determinations on Medicare appeals
•Reviewed cases to determine the facts of each case and assesses issues involved in the case.
•Reviewed files to determine whether all relevant information has been submitted.
•Identified and matched denied item(s) within the case file, the denial rationale presented by the Medicare contractor and arguments of appellants.
•Correctly matched denied items and arguments to Medicare policies.
•Used Internet and hard copy tools to research issues using federal laws and regulations relevant to CMS policies.
• Responsibilities include claims adjustments and written or oral communication to
management, provider or Medical Directors.
Solution Medical Billing Claims Specialist and Medical and Vision Billing
Floyd Medical Billing Co. - Rome, NY
February 2013 to February 2014
Job Responsibilities:
• Answered incoming and placed outgoing calls to account holders and physicians
regarding claims submitted for processing.
•Communicated with physicians, other healthcare professionals and contributed to the development and maintenance of health information networks.
•Reviewed cases to determine the facts of each case and assesses issues involved in
the case
• Identified and matched denied item(s) within the case file, the denial rationale presented by the Medicare contractor and arguments of appellants.
• Research issues using federal laws and regulations relevant to CMS policies
•Outlined pertinent facts and issues for review by independent physician consultants.
•Researched and re-adjudicated claims due to inaccurate or incomplete applications.
Statement of Health Representative Claim Specialist
MetLife
July 2011 to January 2012
Job Responsibilities:
•Answered incoming and placed outgoing calls to account holders and physicians regarding claims submitted for processing.
•Made reconsideration determinations on Medicare appeals
•Reviewed cases to determine the facts of each case and assesses issues involved in the case.
•Reviewed files to determine whether all relevant information has been submitted.
•Identified and matched denied item(s) within the case file, the denial rationale presented by the Medicare contractor and arguments of appellants.
•Correctly matched denied items and arguments to Medicare policies.
•Used Internet and hard copy tools to research issues using federal laws and
regulations relevant to CMS policies.
• Responsibilities include claims adjustments and written or oral communication to management, provider or Medical Directors.
Consumer Advocate
Youth Empowerment Project Incorporated - Utica, NY
June 2008 to April 2010
Utica, NY June 2008 to April 2010
Home Community Supportive Staff Specializing in Patients with Traumatic Brain
Injuries
Job Responsibilities:
•Directed care of residents, acted as consumer advocate, and performed secretarial duties as required.
•Responded to inquiries, provided information and remained flexible and positive.
Assistant Manager Job Responsibilities
Dunkin Donuts - Utica, NY
June 2005 to July 2007
• Processed orders, accepted payment for services order, and made change.
•Responded to inquiries, provided information and remained flexible and positive.
•Unloaded trucks, stocked shelves and trained new employees on operational
procedures.
Dental Customer Service Representative and Claim Specialist
Metropolitan Life
June 2002 to August 2004
Job Responsibilities:
•Answered incoming and placed outgoing calls to account holders, performing account maintenance and updating account information as needed.
•Coordinate concerns with different physicians.
•Correctly matched denied items and arguments to Medicare policies.
Claims Specialist and Medical Insurance Billing/Claim Processing
The Gap
+ Add dates
The Gap in employment from January 2021 to September was due to Covid restrictions
and me looking for Remote positions
Bachelors in Bachelor of Science Business Management in Business Management
Capella University
January 2015
Education
February 2012 to May 2014
Associates in Medical Assistant
Ultimate Medical Academy - Tampa, FL
Computer skills
Front desk
Medical receptionist
Skills
Do you have any of these top skills employers are looking for? Eaglesoft Interviewing
Laboratory Experience Employee Orientation Dismiss ICD-9 - 15 years ICD-9 & 10 - 5 years Customer service - 10+ years Dentrix - 6 years Transcription - 4 years Underwriting - 15 years HIPAA - 8 years Epic Citric RXhome Esi Intergrated Accounts Workspace Genesys Microsoft Teams Web Ex 15 years Medical records Dental receptionist Stocking
Organizational skills Infection control Medical scheduling Medicare Phone etiquette Account management Computer operation CPR Medical imaging Medication administration Medical coding Content management systems Data entry Anatomy knowledge Medical billing EMR systems Insurance verification Medical terminology Quality assurance Dental assisting Assistant manager experience Accounting Computer networking Maintenance Research CPT coding ICD coding Home care Vital signs Chairside
assisting Microsoft Office Cash handling Cashiering Driving Communication skills Leadership Food preparation Administrative experience Workers' compensation
Documentation review HCPCS Typing Behavioral health Google Suite Microsoft Excel SAP
BusinessObjects Google Docs Customer support OSHA Accounts receivable ATS Social media management Talent acquisition Salesforce Sales French Information security Databases DRG Analysis skills ICD-9, CPT-10, Medical Terminology Medical Insurance
Excellent Interpersonal Skills Claim Entry "Payment Posting Records Organization
"Management Insurance "Patient Aging HIPAA Compliance Online Claim Submission "ERA Various Practice Management Software (CMS) Strategic problem solving skills Team Player
Complaints Management skills Electronic Health Records (EHR) Electronic Medical Records (EMR) EPIC Genesis Avatar Medical Law Ethics Add Sections Languages Links Military Service Awards Groups Patents
Customer service
Administrative experience
Word processing
Medical office management
Medical transcription
Office experience
Medical scheduling
Dental receptionist
Medical records
Multi-line phone systems
Typing
Computer literacy
Organizational skills
Clerical experience
Phone etiquette
Time management
Medicare
Medical billing
Insurance verification
Filing
Order entry
10 key typing
Office management
Calendar management
Schedule management
Medical office experience
Computer operation
Certifications / Licenses
Medical Billing Certification
CPR Certification
Assessments
Verbal communication - Proficient
April 2023
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