Customer Service Representative
Resume:
Joyce Cooper
P.O. Box **
Chino, CA *****
OBJECTIVE:
To work in a department that utilizes my training experience and provide challenge and
encourage professional growth.
PROFESSIONAL PROFILE:
2 years and 4 months experience as a Medical, HMO, and Institutional Claims Examiner. Working
knowledge of Medical Terminology, ICD9, CPT4, UB92/1500 forms.
26 years experience with thorough knowledge of Medicare rules and regulations, policies,
procedures and operations.
Highly organized, dedicated and committed to professionalism.
Communicate effectively with all level of employers and management. 2 years and 4 months
experience with thorough knowledge of PPO, HMO, Professional, Outpatient and Inpatient
Claims. 15 years experience as a Customer Service Representative.
EMPLOYMENT HISTORY:
Anthem Blue Cross
Claims Examiner 08/17/2009 to 12/08/2011
EDS/NHIC, CORP
Appeal Reviewer 08/01/2002 to 08/29/2008
Call Center Rep Associate 12/01/2000 to 07/31/2002
Transamerica Life Insurance Company
Customer Service Representative II 05/01/1998 to 11/30/2000
Customer Service Representative I 09/15/1993 to 04/30/1998
Claims Examiner 06/1982 to 09/14/1993
RESPONSIBILITIES:
My training and abilities include:
Handle review requests
Corresponds with physician, suppliers, and beneficiaries, explaining such issues as
deductibles, tracers, etc.
Compose letters responding to inquiries that are received.
Process adjustments/claims.
Handle follow-up activities related to adjustments made.
Reduce incoming appeals.
Responsible to individual and team workload.
Answer incoming calls from beneficiaries and providers.
Answer incoming written correspondence from beneficiaries and providers.
Handle supervisory calls for my co workers from irate clients, beneficiaries and providers.
Help co-workers with their questions.
Perform claims entry function and assist with all related clerical duties to support unit or office.
Accurately process professional and institutional claims.
Analyze and adjudicate claims to ensure accurate payment.
Meet Department Quality and Accuracy Standards.
ADDITIONAL SKILLS AND TRAINING:
Working knowledge of personal computer, windows 95 and 2000, Internet and Microsoft word. I
know how to complete the brand new universal claim form (changed after 15 years) for physician
billing, working in a doctor's office, CPT and ICD-9 coding, Rules and regulations for Medicare,
private insurance, Blue Cross and Blue Shield, Modifiers, what they are and how to use them to
increase reimbursement, How to read explanations of benefit forms, Surgical terms to read an
operative report, HCPCS Coding, Medi-Cal, Tricare, Legal aspects of Collections, Basic of
managed care and how to submit claims electronically.
EDUCATION:
California State University, Dominguez Hills, Carson, CA
BS, Business Administration, 1985
Los Angeles City College, Los Angeles, CA
AA, Business Administration, 1982
American Academy of Professional Coder
CPCA Certificate, 2008
Riverside Community College, Riverside, CA
Certificate in Medical Insurance Billing and Computerized Medical Insurance Billing
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