Customer Care Quality Assurance

DEBRA FRAZIER-GREEN

*.***********@*****.*** 615-***-****

CAREER GOAL:

Seeking responsibilities within the customer care industry, that will effectively utilize my communication, analytical, and organizational skills, to assist in project completion SUMMARY OF QUALIFICATIONS:

• Problem solver with keen strategic planning, problem solver and analytical thinker.

• Proficient in Microsoft Excel, Word, Access, and PowerPoint, inter-company databases and systems such as AS400, MOTRS/AS400, IBM System 390, Salesforce, NextGen, Epic, Enforcer, Mitel, and iConnectData Internet Portal.

EDUCATION AND CERTIFICATION:

National College of Business and Technology- Nashville, TN Medical Billing/Coding, August 2005

Dean’s List 2004-2005, GPA 4.0/4.0, Perfect Attendance New York Institute of Finance, Dividends Course and Certification, 1990 PROFESSIONAL EXPERIENCE:

Robert Half/ Tennessee Orthopaedic Alliance – Nashville, TN July 2024 – Oct. 2024 AR Specialist

• Promptly identify any errors or other issues in claims processing, effectively following up on any unpaid balances, and expeditiously bring any remaining balance to resolution.

• Meet quality assurance and productivity standards by identifying and reconciling insurance balance accounts.

• Identify denial trends and provide potential solutions while analyzing patient accounts utilizing our EPM system.

• Communicate with insurance payer representatives to ensure timely and accurate resolution of account transactions. This would include Commercial plans, Medicare/Medicare HMO plans, Medicaid/Medicaid HMO plans, and BCBSTN; also, Adhere to HIPAA and OSHA safety guidelines.

• Prioritize assigned accounts to maximize aged accounts receivable resolution.

• Review the explanation of benefit (EOB) documentation and notate accounts on collection activity to perform account resolution, review details on denials.

• Operate within established guidelines and protocols, including providing backup documentation for our accounting and audit functions.

First Source USA – Louisville, KY March 2024 – May 2024 Revenue Cycle Billing Agent

• File Claims using all appropriate forms and attachments

• Handle outbound calls and Maneuver between several different software systems

• Research account denials and file necessary appeals

• Evaluate information from the Client to determine which carrier to bill

• Verify Patient Benefits information

• Ensure claim integrity

• Provide detailed documentation of actions taken

Argos/Enablecomp - Augusta, GA May 2022 – March 2024 Account Receivable Specialist - Physician & Hospital Billing

• Proactively identifies delinquent accounts by addressing aging promptly.

• Investigates accounts to pinpoint issues causing payment delays, taking appropriate actions such as appeals, resubmissions, billing to another payer, adjustments, or write-offs.

• Diligently documents billing activities in the system, maintaining comprehensive and accurate records for all accounts.

• Makes necessary adjustments for contractual allowances in accordance with the rules and regulations outlined in contracts with secondary payers.

• Expertly verifies eligibility and authorizations using online tools/resources to check claim status, eligibility, and referral/authorization information.

• Manages payment posting and conducts thorough balance reviews.

• Implements a 72-hour ER notification process

Asurion. Inc. – Nashville, TN Jan. 2012 – May 2022 Universal Customer Satisfaction

• Responsible for partnering with various departments across the business to resolve issues that may arise

• Responds to subscriber inquiries, escalations, and complaints and Responsible for resolving complex escalated customer issues

• Proactively engage and communicate process improvement initiatives

• Develop tracking tools used for trend analysis and customer concerns Asurion, Inc. - Nashville, TN March 2007 - July 2011 Verifications Service Representative

• Responsible for the verification of all claims in T-Mobile and obtaining enrollment information data to input into the claims system.

• Maintain the status of all claims once verified in an acceptable turnaround manner that requires efficient and accurate reporting.

COMDATA NETWORK, INC.- Brentwood, TN Jan. 2004 – May 2006 Client Relations Representative

• Set up corporate and card level new account information, business rules and fees in all databases, invoicing and reporting modules.

• Order customer cards, supplies, MOTRS/AS400 software, Welcome Kits and other customized client information and marketing collaterals.

• Schedule appointments to train customer on products and procedures, as well as reports and services provided via iConnectData, Connect Mailbox and the Comdata mainframe. STATE STREET CORPORATION, FKA Deutsche Bank - Nashville, TN Dec. 1986 - June 2003 Client Reporting Specialist

• Audited financial statements and resolved client questions concerning audit discrepancies.

• Coordinated team activities for accounts transitioning to new accounting platform.

• Team Leader charged with training new administrators.

• Client Reporting Administrator

• Provided audits and reconciliation of 1099 on a monthly, quarterly and annual basis.

• Implemented and updated MIS reporting for managerial and client review.

• Raised over $44,000 for American Heart Walk Campaign as Company Leader and Team Captain

• Senior Administrator

• Worked closely with international clients in the prompt resolution of client issues and inquiries.

• Managed workflow scheduling and team projects.

• Implemented cross training of administrators in global accounts’ procedures and guidelines

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