Insurance, Operations, and Finance Specialist
Resume:
Joyce RaNae Aven-Bond
PROFESSIONAL RESUME’
Denham Springs, Louisiana 70726
*****.********@*****.***
OBJECTIVE
To obtain a position with a successful company or organization where I can utilize my Insurance, Business Management, Financial and Quality Control skills.
EDUCATION
NEW ENGLAND COLLEGE OF BUSINESS AND FINANCE
May 2009 through August 2011
Major course of study – Business Management
BOB BROOKS SCHOOL OF INSURANCE AND REAL ESTATE
June 2004
40-hour pre-licensing course – Health/Life Insurance
DENHAM SPRINGS HIGH SCHOOL, DENHAM SPRINGS, LOUISIANA
1982-1986
1986 Graduate
EXPERIENCE
CUSTOMER SERVICE AGENT II SUTTER HEALTH
October 2023 – Present
Providing advanced, high-quality support to patients and staff, handling complex inquiries via phone, email, and portal.
Inquiry Management: Receives and resolves complex, high-level patient, employee and provider inquiries regarding billing, insurance, and system services.
Relationship Management: Builds strong connections to ensure high patient satisfaction and identifies service improvements.
Administrative & Data Processing: Handles patient scheduling, updates accounts, and maintains data accuracy.
Compliance: Adheres to all local, state and federal regulations regarding patient privacy and security.
Problem-Solving: Identifies, interprets, and researches issues, providing first-contact resolution whenever possible.
I have exceptional verbal and written communication skills, strong interpersonal skills, and proficiency with tools/systems.
I attribute empathy, patience and the ability to manage stressful situations professionally.
I have a work at home environment which requires a stable private workplace which requires working in a high-volume, structured call center setting.
My high performance is measured through metrics, including call volume and resolution times.
FINANCIAL/OFFICE MANAGER SPINE AND BODY PHYSICAL THERAPY, INC.
July 2011 – June 2012
Meet, greet and build relationships with patients
Give tours of clinic and demonstrate equipment
Obtain authorization for Managed Care and Work Comp contracts
Maintain all charts and perform chart audits
Process and collect all payments
Assist in the treatment of patients under the supervision of the Physical Therapist or Physical Therapist Assistant
Assist in the marketing of our facility and the physical therapist
Enter daily charges from super bills and physical therapy notes
Electronically bill all charges daily to insurance companies and produce monthly statements to patients and attorneys
Provider Credentialing
FINANCIAL MANAGER LEWY PHYSICAL THERAPY, INC.
July 2008 – June 2011
Audit patient charts to ensure accuracy of required documentation and charges were being billed for all services performed
Handle all major insurance company accounts (auto and health)
Approve or deny payment arrangements requested by attorney or patients
Follow up with collectors to ensure all collection procedures were followed
Handle problem accounts that could not be collected on and determine steps to take to resolve the account
Review all old and uncollected accounts to determine other actions to take for resolution
Monitor front desk to make sure all money is collected up front for copays
Produce monthly statements to patients and attorneys
Send certified lien letters to all attorneys and auto accounts
Provider Credentialing
FINANCIAL/OFFICE MANAGER DUTCH PHYSICAL THERAPY, INC.
April 2003 – July 2008
Meet and greet all patients
Make sure all follow-up appointments are scheduled
Supervise front desk receptionist and make sure all copay and coinsurance payments are collected upon each visit
Audit all charts for accuracy in notes and billing
Electronically bill daily to all insurance companies
Produce monthly statements to patients and attorneys
Run collection reports to ensure all goals are met
Post all payments received from patients, attorneys and insurance companies
Run daily reconciliation reports
Provider Credentialing
Make daily deposits
CLAIMS/CUSTOMER SERVICE SUPERVISOR/ BENESYS (HUVAL COMPANIES)
January 2001 – March 2003
Made amendments and updates to policies and procedures manual
Recruit and hire claims processors and customer service reps
Train new hires on communication and interpersonal skills needed to successfully complete their daily tasks
Handle all problem customers or clients and resolve any issues or complaints from the customers
Analyze statistical data and keep track of all developments and increases in the profits of the company
Attend monthly and quarterly business meetings with managers and high-level administrators within the company
BLUE CROSS BLUE SHIELD OF LOUISIANA
(1990 – 2001)
SPECIAL CLAIMS PROCESSOR / BLUE CROSS BLUE SHIELD OF LOUISIANA
November 1990 – December 1992
Enter coded information at 4500 keystrokes per hour
Check claims for completeness and accuracy of information prior to final entry
Identify and resolve inconsistencies and appropriately return claims requesting missing information in accordance with established quantity, quality, and timeliness guidelines to ensure contract benefits are applied correctly
Identify training issues
Identify incomplete adjudication instructions found within the manual and offer suggestions for correct adjudication procedures
Consistently research procedural questions using the edit manuals
Maintain and record information necessary for the Work Management Module
Retain historical data needed to continually refine and define the special claims processor position as needed to ensure high customer satisfaction skills
SCANNED CLAIMS EDIT PROCESSOR / BLUE CROSS BLUE SHIELD OF LOUISIANA
December 1992 – January 1993
Review and correct scanned documents upon receipt of edits to ensure accuracy of claims
Reject or send back claims when information is incomplete or inaccurate
Identify and redirect misrouted claims to facilitate timely processing of claims and ensure correct processing of claims in the appropriate department
Verify entered information prior to final entry to facilitate accurate and timely processing of claims
Research procedural questions in the training manual.
ADJUSTMENT PROCESSOR / BLUE CROSS BLUE SHIELD OF LOUISIANA
January 1993 – February 1994
Research, review and make necessary adjustments received through AR, memos, recons, audit, financial investigations, or changes in coverage on all types of contracts handled by the company
Manually calculate all benefits when needed to ensure claims are paid correctly according to contract benefits ultimately providing a high degree of customer satisfaction.
QUALITY CONTROL/AUDIT REVIEW / BLUE CROSS BLUE SHIELD OF LOUISIANA
February 1994 – January 2001
Audit claims, adjustments, and edits to identify accuracy and inaccuracy of services and processes
Review all processed work pending for audit with established manuals and other information for correct coding in all systems related to the type of work audited
Prepare reports on findings
Inform management of findings and suggestions and advice whether education and additional training is necessary on processing practices and compliance issues to rectify the finding of consecutive errors and overpayments
Resolve errors contested by managers and recognize changing guidelines and requirements diplomatically to maintain relationships with operational areas to ensure audit accuracy
Conduct audits of operational areas while maintaining many all-special audit cases, reporting savings to management
Assist audit coordinators with technical aspects of claims review and training
Verify accuracy of all claims processing Researching and clearing edits
Recalculating payments
Identifying, analyzing and documenting possible system errors/patterns
Screening claims for indication of possible fraud
Conduct audits of operational areas to determine compliance with all relevant policies, regulations, and procedures
REFERENCE:
Marvin Louviere, Owner of Spine and Body Physical Therapy,
Phone: 985-***-****
Gayle Foster, Supervisor at Blue Cross BlueShield of Louisiana,
Phone: 225-***-****
Nikki Murphy, Owner of The Hidden Door,
Phone: 225-***-****
Contact this candidate