Customer Service Quality Assurance
Resume:
TONGA E. PYLES
Stone Mountain, GA 30083
*****.*****@***.***
EDUCATION
Thibodaux Area Vocational Technical School, Secretary/Stenographer
Professional Career Development Institution, Medical Billing
SKILLS
Data Entry 10,000 keystrokes per hour, Typing 75 wpm, MS Office Suite, Omni Track, Event Tracker (ticketing systems), SIR (doc mgmt), MHN (Medicaid System), GHP Webportal, UB 92 and HCFA Forms
PROFESSIONAL EXPERIENCE
ATLANTA BILLING SPECIALIST (ABS), Atlanta, GA 07/2011-09/2011
Accounts Receivable Specialist
Verify insurance information using MMIS Web Portal
Processing Medicaid Claims through Centricity/IDX
AFFLIATED COMPUTER SERVICE (ACS) Atlanta, GA 03/2003-11/2010
Georgia Medicaid
Claims Specialist
Pulled reports from the Reprocessing Database for claims that need to be reprocessed due to keying errors
Forward appropriate claims to RMO for reprocessing
Reprocessed/adjusted in house any claims that cannot be forwarded to RMO for reprocessing
Created/released reprocessing requests via the System Generated Adjustment Window for claims approved by Medical Review
Reprocessed requests from Customer Interaction Center, Correspondence and Management
Correspondence Specialist
Researched and responded to 1000+ incoming written and electronic correspondence from clients within 72 hours.
Tracked and recorded daily correspondence through electronic ticketing system.
Educated 50+ clients monthly on billing policies
Provided solutions to clients billing questions.
Customer Service Representative Specialist
Educated the Medicaid members and providers about the Medicaid plan
Maintained working knowledge of policy and procedures, updates and changes
Answered 100+ call daily, while resolving escalated billing issues from clients and providers.
Met Quality Assurance guidelines of 95%-100%
ELECTRONIC DATA SYSTEM (EDS) Tucker, GA 06/2000-03/2003
Imaging Clerk
Maintained a standard production of 8,000 keystrokes per hour in the repair modes
Utilized form works manager to distribute batches to staff
Processed all Medicaid claims productively and timely
Maintained quality rates of 95% or better on all claims
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