Service Representative Customer

Tonja M. Jones

Columbia, TN *****

**************@*****.*** 931-***-****

Professional Summary

Highly organized and purposeful healthcare support professional with experience in administrative operations, provider communications, and payer coordination. Demonstrated success in managing complex provider enrollment processes, ensuring compliance with Medicaid regulations across multiple states. Skilled in preparing and submitting enrollment applications, resolving deficiencies, and maintaining meticulous documentation. Adept at fostering productive relationships with providers, Medicaid agencies, and cross-functional teams to expedite approvals and ensure timely reimbursement. Proficient in Microsoft Office, with a strong ability to manage competing priorities, maintain accuracy under pressure, and communicate effectively with both internal stakeholders and external partners. Passionate about supporting healthcare operations that streamline access to care and improve provider efficiency.

Core Competencies

Collections & Account Resolution

Payment Recovery Reimbursement Claims Credit Disputes Loan Processing

Customer Communication & Conflict Resolution

First-Call Resolution Escalation Handling Call De-escalation Bilingual Communication (Preferred)

Operations & Compliance

Regulatory Adherence Document Accuracy High-Volume Call Management HIPAA & Legal Collaboration

Technical Proficiency

CRM Systems Microsoft Office Suite Remote Workflow Tools Application Processing Salesforce

Professional Experience

McKesson – LaVergne, TN (Remote)

Senior Acute Customer Service Representative

2022 – Present

Proactively facilitated and streamlined high-volume insurance and order management inquiries, averaging 90+ daily touchpoints.

Conducted Tier 1 troubleshooting and identified discrepancies in claims and billing details.

Accurately documented account activity in Salesforce and SAP CRM, ensuring timely updates for claims follow-up.

Escalated complex insurance and product-related issues, aiding in faster claim processing and reimbursement.

Prevented $25K+ in losses by identifying and escalating fraudulent transactions.

Consistently maintained 100% monthly QA scores and 0.42-minute average handle time.

The Cigna Group – Remote

Patient Support Care Advocate

2022

Resolved claims and eligibility issues with 97.5% accuracy while maintaining HIPAA compliance.

Educated members on Explanation of Benefits (EOB), billing concerns, and plan coverage.

Logged all member interactions and claim follow-ups in CRM systems to ensure timely resolution.

Supported Medicare and commercial plan members with denial clarification and appeals guidance.

Ford Motor Credit Company – Franklin, TN (Remote)

Senior Credit Re-Analysis Customer Service Representative

2000 – 2022

Served as an Escalations Liaison handling high-profile customer accounts with high accuracy and professionalism retaining 95% of at-risk accounts through strategy issue resolution.

Managed compliance reviews, exceptions reports, flagged discrepancies, and ensured claims accuracy across systems.

Delivered Tier 1 negotiated collection efforts partnering with legal and compliance teams on credit disputes and internal and cross-functional teams improving resolution times by 25%.`

Partnered with legal and compliance teams and contractors on credit and collection disputes and insurance claims.

Soft collections managing 500+ delinquent account with a monthly collection target of 100,000 and routed hard collection skip-tracing efforts to appropriate department.

Investigated skip-tracing accounts using advanced tools and successfully recovered 25% of outstanding revenue contributing to overall portfolio performance.

Prepared, entered, and submitted transfer of equity applications and decisioned the transfer approvals.

Managed payer follow-up for new loans and adherence to data entry requirements.

Work directly with transfer of equity applicants to secure any court documents, required documents, state requirements, and any signatures to complete the onboarding/enrollment process.

Overseer of payment processing workflow que.

Buffalo Valley – Lewisburg, TN

Intake/Enrollment Family Advocate & Rehabilitation Manager

2013 – 2018

Verified and advised insurance eligibility obtaining authorizations, ensuring compliant patient onboarding.

Coordinated cross-functional case reviews to improve approval rates for patient care plans.

Educated families on healthcare and insurance processes, enhancing claim accuracy and appeal success.

Coordinated all necessary provider enrollment applications for data entry and billing purposes.

ResCare – Columbia, TN

Intake Manager / Program Coordinator

2013 – 2019

Conducted eligibility assessments and resolved coverage issues with insurance providers.

Accurately recorded claim-related interactions, supporting documentation for audits and billing cycles.

Partnered with internal teams to ensure accurate claims data entry and reduce delays in reimbursement.

Education

Bachelor of Science in Business Administration

American InterContinental University

Concentration: Organizational Psychology and Development

Associate of Arts in Business

University of Phoenix

Medical Billing and Coding Certificate

Columbia State Community College (ED2GO Program)

Certificates

HIPAA Compliance (In-House)

Medical Billing & Coding (Certificate Program)

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