Administrative/Customer Service Professional with Paralegal

Cynthia Kernats

**** ******** ***

Downers Grove, IL 60516

708-***-****-Cell

*********@*******.***

SUMMARY

A Professional with a Bachelor’s degree in Business Administration from Lewis University and Paralegal certification from Robert Morris College. Experienced in the Medical and Legal field with many Administrative and Customer Service skills. I am a motivated, detail-oriented, organized team player with strong communication and interpersonal skills. I am seeking an opportunity to contribute my experience and skills to the success of an organization.

PROFESSIONAL EXPERIENCE

Home Care Delivered-Durable Medical Equipment Remote Call Center-Customer Service Rep II- March, 2024 to present-Remote

● Take Inbound calls from patients/caregivers needing to order DME supplies such as Diabetic, CGM; Incontinence; Ostomy; Urology, etc.

● OBC made to patients via dialer regarding Order statuses; need for PA or LOMN or Doctor Orders;

● Request Doctor Orders for supplies; Prior Authorizations; Letters of Medical Necessity;

● Provides patients with a comprehensive explanation of required documents and how to complete required documents, as necessary.

● Intake: Accurately performs each step in the process from order to ship. This includes initial engagement and customer intake, data entry to build the order, insurance verification, prior authorization as needed, gathering, and verifying proper documentation, and completing the shipping process

● Maintain accurate patient acn throughout the process

● Consistently ensures compliance with established regulatory requirements and department and Company standards and procedures

Included Health-Care Coordinator-Medix Recruiter-6 month contract position July, 2023-February, 2024-Remote

● Effectively handles inbound calls from members regarding verifying members' benefits, advising and explaining what members' Deductibles, Co-pays, and Out of Pockets are; statuses of claims, requests for medical records;

● Offering members Triage Care if they are ill and don't know what actions to take and transferring to Triage;

● Offer members many eligible benefits that Included Health provides employee insurance members;

● Schedule Virtual PCP and virtual behavioral health appointments for members;

● Calls to carriers regarding explanations of claim(s) denials;

Enova International November, 2022-July, 2023

CashNetUSA-Remote

● Effectively handle inbound and outbound calls to customers regarding overdue loan payments

● Utilize problem-solving skills to find customer-specific solutions for delinquent accounts

● Ensure superior customer service through excellent verbal and written communication

● Maintain accurate, up-to-date information for customer accounts

Allied Benefit Systems-Remote

LaSalle Staffing, Chicago, IL -Temp Position November, 2021-November, 2022

Call Center Customer Service Representative

● Take Inbound calls for various Insurance Companies for Medical, Dental, and Vision Claim Statuses, Quoting benefits, and Eligibility for providers and members (eg: Deductibles, Co-Insurance, Out of Pocket Max);

● Take Inbound calls as a Pharmacy Customer Service Representative answering calls relating to pharmacy claims and benefits; searched for status of preauthorization approvals and denials; searched J codes to see if an injection/infusion required a precertification

United Health Group-OptumRx, Downers Grove, IL November, 2017-November, 2021

Customer Service Advocate-Pharmacy Benefit Manager

● Respond to incoming calls from customers on issues related to benefit eligibility questions and prescription status inquiries; ● Guide and educate callers on their prescription benefits, use of plan, formulary, premiums, and status of orders and claims or inquiries; ● Ask appropriate questions and listen actively while documenting required information in computer systems; ● Identify issues and communicate solutions and steps to customers, pharmacies, and physicians with prescription orders and reorders; ● Make outbound calls to customers on prescription orders and payment issues; ● Research complex issues about member prescription and/or pharmacy benefits across multiple databases that require fluency in computer navigation and toggling while confidently and compassionately engaging with the caller;

ACCENT-Cigna Healthcare, Tinley Park, IL

Overpayment Recovery Specialist November, 2015-November, 2017

Duties included, but were not limited to: ● Made outbound calls to providers in billing departments of hospitals or physicians' offices regarding medical claim overpayments by reviewing accounts and explaining reason codes for claim overpayments; explaining how the claim was processed and how to correct the claim to get it reprocessed as to not have an overpayment; ● Provide overpayment letters to providers (by fax, email, or phone) to render overpayments on accounts; ● Negotiate with providers to get payments sent in to make monthly goal; ● Work with spreadsheets sent to providers of all accounts about their practice on overpayments

EDUCATION

Bachelor's Degree in Business Administration, Lewis University, Romeoville, IL 1998

Associate Degree in Business Administration focused on Legal Assisting 1996

Paralegal Program Certification, Robert Morris College, Orland Park, IL 1994

TECHNICAL SKILLS

Microsoft Word, Excel, Outlook, Microsoft Teams, Zoom, Red Card, DocuVantage, Julian Calendar, EPIC; Nextgen, Sorian; Availity, Navicure, and Connex, AS400 database; Cigna Citrix Systems; CSCL; Benefit Point; IRIS, E-Clinical; Navigator; Aperture; Genesys Cloud; Medical Terminology; strong typing skills, excellent communication skills; proofreading, computer and telephone skills

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