Customer Service Representative
Resume:
Roshonda Nash
Hagerstown, MD 21740
Cellular 646-***-****
E-mail ***********@*****.***
Objective: Skilled claims professional with an eye for accuracy and detail, Comfortable in interacting with all levels of the organization and public. Excellent problem solving and negotiating skills. Able to make decisions independently and quickly with minimal escalations. Known for taking initiative and skilled at meeting challenges and deadlines.
Professional Experience:
Ashley Furniture 2023-Present
Customer Service Representative
Resolving customer queries and problem to their satisfaction in a short time as possible
Attending to walk-in customers and taking inbound calls
Processing customers invoices and payment transactions using POS terminals as well as processing financing applications.
Maintained organized documentation and filing systems for efficient access to customer records.
Ensured smooth checkout operations by adhering to policies and procedures.
Alteon d/b/a US Acute Care Solutions 2022-2025
RCM A&R Workers Compensation / Medicare / Medicare HMO
Responsible for the timeliness and accuracy of all aspects of workers compensation, Medicare and Medicare HMO.
Performed claims processing which included investigation of claims and the determination of compensability.
Manage special projects and perform complex duties related to bill review and follow up.
Maintained high level of confidentiality in handling clients' medical claims, including knowledge of HIPPA.
Liaised with healthcare providers to request and review medical treatment notes to adhere to strict recovery timeline and payment timelines to efficiently process claims closures.
Alteon Health 2020-2022
Team Lead/ Supervisor - Customer Service
Develop a positive team relationship by being supportive, visible, and easily accessible.
Coached employees to develop strong customer support skills to minimize process issues and meet customer expectations.
Identified call trends to improve efficiency, reduce problem calls and suggest solutions to upper management.
Provide outstanding customer service through the support of escalated customer service issues.
Participated in the growth of Telemedicine which is the remote diagnosis and treatment of patients using telecommunications technology such as smart phones devices, tablets and /or Desktop computers.
Appropriately examine electronic health records in EPIC to ensure proper sequence of documents, presence of proper reports and signatures, and inclusion of sufficient data to document diagnosis, treatment rendered, and results obtained.
Responsible for registering and claim creation for our Dataless claims in Athena.
Alteon Health 2019- 2020
Billing Support Specialist Customer Service Representative
Receives calls and conduct reviews of patient accounts distributed by automated call center system, during established call center hours.
Handling all aspects of insurance claims processing including benefit verification, payments posting (payer and Patients), EOB review, denial management in compliance with payer guidelines.
Receiving and responding to oral and written patient correspondence within allotted time frame.
Posting account receivable documentation such as patient discounts, contractual adjustments, and charity adjustments to patient accounts.
Update demographic and insurance information in Athena Health EHR System and Nextgen Healthcare Systems.
Performing services in accordance to the company’s, state and Federal regulations and guidelines.
Respond to Attorney requests Utilizing ChartSwap.
Knowledge of Athena, Verinet, Power BI, Cedar and other various applications.
Healthfirst 2015-2019
Senior Claims Examiner - Telecommuter
Responsible for investigating claims and encounters for medical, facility, pharmacy, dental and vision services including contractual provisions, authorizations and Healthfirst Policy and Procedure.
Subsequent auditing and handling of specific claims and appeal requests including processing where applicable, tracking, documenting, reporting and dispersal of findings and recommendations
Identifying defects and improving departmental performance by supporting quality, operational efficiency, and production goals. Reporting and presenting preliminary findings based on trending and interpretation.
Working with staff in other business areas to assist with the resolution of complex provider issues.
Analyzing reports utilizing Microsoft Office Excel, Macess, Power MHS, Cotiviti, Epaces, and other reporting tools.
Overturned more than $9 million in claims that were processed incorrectly
Examining and Processing of Claims. Working on multiple audits, appeals or other ad hoc projects.
Monitored health claims entered into Managed Health Solutions (MHS)
Healthfirst 2014-2015
Claim Examiner - Telecommuter
Entered Inpatient and Outpatient members various medical claims including HCFA’S 1500’ s and UB’s 92 utilizing (MHS)
Processed Medicare and Medicaid claims for dually enrolled members.
Screened HCFAs and UB92s for complete subscriber and provider information.
Corrected provider and member identification numbers on invalid claims.
Performed Claim adjustments to correct erroneous payments (over /under payments).
Participated in special projects involving the data entry of claims submitted by providers.
Programs : Epaces, Epic, Athena, Chart swap, Legal Files, OnBase, Onesource, RJ Health, Excel, Mircosoft Word, MHHS, Noridian, NGS(National Government Services), Nextgen, and Macess.
Education:
Flushing High School –Academic Diploma–
LaGuardia Community College - Twelve credits
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