Customer Service & Data Entry Specialist with HIPAA Expertise

THELMA MESSENGER

*************@*****.*** +1-863-***-**** Lakeland, Florida

Summary

Talented Customer Service Representative Self-starter, motivated and Compassionate team player. Expert in identifying and reaching milestones and managing time wisely. Highly organized leader with great attention to detail.

Skills

ACD (5 years)

AMISYS (5 years)

AVAYA (5 years)

CRM (1 year)

Customer Service (10+ years)

Call Center (8 years)

Bilingual (10+ years)

Excel (6 years)

Outlook (10+ years)

Word (10+ years)

PeopleSoft

Medical Records (10+ years)

HIPAA

Microsoft Office (10+ years)

Data Entry

Typing (10+ years)

Medical Terminology and coding trained

Insurance Verification (8 years)

Windows 8, 10, 11

Microsoft Word

SAP

Documentation review

Analysis skills

CPT Coding

Accounts payable

Awards

5 year awardFor my dedication.

Regional Champion For most credit card applications.

Lotus 1,2,3. Windows Platforms

95, '98, '00, 'NT, XP Vista, Medical Manager, PeopleSoft,

Oracle, Avaya, Facets, Amisys, Compass, 45+ WPM, ACD Phones.

Experience

Qlarant Easton, MD

Project Support Specialist II

06/2020 - 05/2023

Responsible to answer phone calls with efficiency and timely action, Reviewed accounts for accuracy, sent correspondence to clients via email, mail or phone, made decisions on case information and sent to CMS. Gathered information by interviewing callers, analyze, files, worked prior authorizations and input information for physicians request, recording, claims processing, examined claims forms for completion and eligibility. Responsible to make and revised payments through clearing house, and reviewed for completion of Excel worksheet. Responsible for entering data using a laptop and using multiple systems and also using Microsoft Office, Windows, Word, Outlook, Excel etc. to complete tasks.

Accessing sensitive records and keeping privacy records compliance with HIPPA laws, state and Federal regulations, downloading case records into drive for completion and retention of records and executing disposal procedures.

Responsible for speaking with agencies regarding case status, deciding which financial information to include in case notes, verifying location or whether eligible for services with companies guidelines. Also continuous communication through chat program with other departments.

Reviewing detail information and completing inventory reports for management on Excel spreadsheet.

Responsible for resolving challenges, and providing friendly service while supporting staff.

Humana Corporation Tampa, FL

Customer Service Representative

05/2014 - 07/2015

Responsible for taking inbound calls and making outbound calls as needed

Responsible for answering questions regarding plan benefits from Medicare beneficiaries and Medicaid recipients and made decisions on case information and provided detailed documentation. Responsible for coaching physicians and other medical staff to process medical claims for Medicaid and Medicare coverage, resolved issues with eligibility, coverage, claims, submissions, corrected, rejected claims and general Customer Service with highest standards of excellence.

Responsible for Averaging about 60 to 70 calls per day, assisted Members with questions regarding benefits, enrollment verification, prescription drug coverage, rejections on claims and updating member demographic information.

Coventry for Aetna Tampa, FL

Service Operations Specialist

02/2013 - 05/2014

Responsible for maintaining high productivity standards to meet metrics, conducted research for Workers Compensation benefits and search eligibility, verify enrollment, claims processing and status

Process all types correspondence, calculated weights, time-frames for express mail, calculated all shipping costs, completed audits on medical claims and rejected medical claims in a timely manner

Typed reports for managerial staff using Excel spreadsheet while being accurate and providing excellent customer service skills

Reconciled ledger through accounting principles.

Hiregy for Wellcare Tampa, FL

Member Engagement Representative

10/2012 - 11/2012

Responsible for making Outbound calls to members Medicaid and Medicare recipients for Health Risk Assessments.

Responsible for Updated status on Excel spreadsheets and complete reports on a monthly basis for managers

Provided general Customer Service assisting members with questions about benefits, enrollment verification, prescription drug coverage, and updating member information, audited claims submissions.

Sam's Club Tampa, FL

Cashier/Customer Service

05/2003 - 07/2011

Started as a cashier for about 2 months then went to membership desk where I sold many memberships and became the regional top credit card sign ups generator, was promoted to Electronics department and I learned all the specifications of all the software and electronics we had in inventory and sold so much that they promoted me to handle all business accounts.

Amerigroup Corporation Tampa, FL

Customer Care Representative

11/2005 - 01/2011

Responsible for assisting providers with credentialing status questions

Provided telephonic assistance to members, who received Medicaid benefits, providers, billing agencies, and various company department staff

Provided effective customer care through superior customer service methods, problem solving and real time issue resolution that promoted member and provider retention

Resolved and involved in issues regarding the membership

Explained benefits, eligibility status, and member enrollment process and procedures to callers

Verified the status of authorizations and/or referrals

Processed complaints, followed established guidelines.Assisted company departments with various tasks (complications) involving the membership.Familiar with and maintained knowledge of state guidelines, regulations, and departmental policies

Achieved:

Exceeded quality 11 months out of the year

Received high scores on annual reviews

Awarded perfect attendance in most of my work history

Exceeded productivity all year long while employed at Amerigroup.

Education and Training

Saint Leo University Online

Associates in Liberal Arts and Sciences

Expected in 10/2028

Bloomingdale High School Valrico, FL

Diploma in General Curriculum

06/1995

Brewster Technical Center Tampa, FL

Certificate Health Unit Coordinator

06/1995

Languages

Bilingual(English/Spanish)

References

Upon request.

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