Customer Service Medical

Viola Starks

Decatur, GA ***** 404-***-**** (Mobile) email: **************@*****.***

SUMMARY OF QUALIFICATIONS

Highly skilled Claims Administrator offering outstanding customer service in medical claims for HMO, PPO and COBRA in the healthcare industry. Performs medical record and claims reviews to make payment based on insurance coverage, billing and benefits verification.

CORE STRENGTHS

Systems Management for Electronic Medical Records Alpha/Numeric Data Entry (9000 KSPH)

Excellent Verbal and Written Communication skills Experience claims adjudication

Highly effective customer service/ public relations

Skilled in Healthcare Operations and Medical Terminology Confidential Records Management utilizing HIPPA regulations

Utilizes Microsoft Office Suite

Ability to work in a team environment

EDUCATION

LEGAL SECRETARY: 1986

BROWN COLLEGE OF COURT REPORTING, ATLANTA GEORGIA

SECONDARY EDUCATION: 1985

GORDON HIGH SCHOOL, DECATUR, GA

RELATED EXPERIENCE

HEALTH PORT, ALPHARETTA, GEORGIA 07/2008-02/2011

PATIENT INDEXER/GENERAL EXCEPTIONS SPECIALIST

• Plan, develop, maintain and operate a variety of health record indexes and storage and retrieval systems to collect, classify,

store and analyze information.

• Protect the security of medical records to ensure that confidentiality is maintained.

• Reviewed and executed all sensitive data for medical request inquiries.

Provide administrative support and assisted in customer invoicing, billing, record printing and shipments

Assisted field representatives with requests for electronic medical records for various customers.

COMCAST, ALPHARETTA, GEORGIA 10/2007-07/2008

CUSTOMER ACCOUNT EXECUTIVE

• Handle customer inquiries, complaints, billing questions and payment extension /service requests. Calm angry callers, repair trust, locate resources for problem resolution and best option solution.

• Managed a high volume work load in deadline driven environment and consistently met performance goals in all areas.

• Compiled and processed account payments, billing and service adjustments.

• Researched status of installation and service calls in order to resolve customers’ complaints.

• Worked in teams and in a self directed environment.

• Initiated upgrades of current services and provided rate and programming and installation information.

BLUE CROSS BLUE SHIELD , ATLANTA, GEORGIA 07/1999 - 04/2006

CLAIMS ASSOCIATE/CLAIMS SPECIALIST

• Prepare and process professional and hospital claims for Blue Cross Blue Shield of Georgia

• Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation

• Compile and prepare incoming mail for departmental account allocation.

• Review and identify incorrectly dispatched documentation prior to scanning.

• Verify and review eligibility for premium group holds such as COBRA, Medicare and Coordination of Benefits.

• Review records for completeness, accuracy and compliance with regulations.

• Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.

ELECTRONIC DATA SYSTEM, TUCKER, GEORGIA 06/1991 -07/1999

INSURANCE CLERK

• Adjudicate medical claims for DME/Orthotics and Prosthetics Unit.

Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment.

• Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status, and verification of claim eligibility.

• Access document and prepared all claim types for microfilming and scanning.

• Documented returned mail orders to Medicaid providers.

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