Part-Time Nights/Weekend Customer Support Candidate

PROFESSIONAL EXPERIENCES:

Healthcare Professional with a strong foundation in Medical Records Management, Data Interpretation, and Administrative Support. Skilled in Customer service and building relationships, with a commitment to growth in the Healthcare field. Key skills and characteristics include:

· In-depth Healthcare knowledge · Excellence Customer service · Issue Resolution

· Exhibits Discretion & Integrity · Collaborative Team Player · Independent initiative-taker.

PROFESSIONAL EMPLOYMENT HISTORY:

Humana, Inc., Tampa, FL March 2019 – Present

Inbound Contact Representative 2

Address customer needs, including complex benefit questions, resolving issues, and educating members of the Group Medicare Retired Benefits Plan for Humana Medicare Advantage Plan.

Manage calls from PDP /MAPD Members regarding real-time pharmacy benefits: copayments, coinsurance, and prescription drug coverage.

Record details of inquiries, comments, complaints, and transactions following internal and external standards.

Assist group members by reviewing and explaining claim dispositions with empathy and compassion.

Recognized as a top quarterly performer for quality performance and consistently achieves Voice of Customer (VOC) targets.

Anthem Health Care, Tampa, FL October 2007 – June 2018

(Formerly known as Amerigroup Health Care, WellPoint Health)

Financial Ops Recovery Specialist I September 2014 – June 2018

Determined and calculated overpayments and issued refund request letters.

Processed voluntary refund payments from providers and adjusted claims based on refunds received.

Reviewed and researched check payments received via multiple avenues.

Grievance/Appeals Analyst I January 2014 – September 2014

Researched and analyzed appeals from providers.

Determined recommended appeals decisions based on protocols.

Manage large and small projects from the different Health Plan Markets.

Received checks via computer from CCU RNF (Refund Notification Form) from providers for claims process in error or overpayment.

Research Claim Analyst, October 2007 - January 2014

Researched and adjusted claims to determine processing errors and made corrections.

Played an integral role in property tracking procedures to increase accuracy and accountability.

Qualified for a quarterly productivity bonus for all quarters and promoted to a new position within a year.

Received checks via computer from providers for claims processed in error for overpayment.

EDUCATION & TRAINING:

St. Petersburg College, St. Petersburg, FL December 2023

Associate in Science – Health Information Technology - Health Science

Certificate - Healthcare Data Management

Brewster Technical Center, Tampa, FL June 1996

Diploma of Medical Secretary

CERTIFICATIONS:

Registered Health Information Technician (RHIT) - Credentialed by AHIMA, March 2025 Certification #275906

COMPUTER/TECHNICAL SKILLS:

· Medical Terminology · RxNova/Rx Connect Systems

· Knowledge of HIPAA Compliance · Data Entry/Records Management/Scan

· CI (Clinical Information Systems) · CAS (Claims Processing Experience)

· Referral Specialist (Case Management Coordinator) · Patient Assistance Clerk

· Written Correspondence/ Attention to Detail · Filling/Scanning Documents

· IVR Softphone/Geneysis Cloud/Email · Basic Knowledge of EHR/ EMR Systems

· MS Office Suite (Word, Excel, Outlook) · CRM (Customer Relationship Management)

Contact this candidate