Customer Service Medical
Resume:
Dywayne J Alston
** *. ****** **** *** #**, Philadelphia, PA 19119
215-***-**** (mobile), 215-***-**** (home)
*************@*****.***
PROFESSIONAL SUMMARY
I’m a hard-working individual with an extensive work experience in all areas of customer services, such as the medical, insurance, hospital, auto and laboratory industry. Strong analytical, time management, organizational, multi-tasking, attention to details, self-motivated, integrity, accountability, and work well independently and a team player and research skills. Able to maintain production pace in a call center environment.
TECHNICAL SKILLS
Microsoft Word, Excel, and Outlook, 35wpm
PROFESSIONAL EXPERIENCE
Procura Management Inc., Norristown, PA November 2011 to May 2012
Medical Billing Review
Perform responsibility for providing quality customer service while handling all incoming provider calls and providing administrative support services.
Responsible for answering questions and concerns; logs calls and sort and tracks all messages for consultation with supervisor on a daily basis.
Ensures provider phone calls are returned within 24 hours.
Access account profiles for phone numbers to direct providers to accounts to inquire on bill payment.
Retrieves and sends information to and from providers via e-fax or fax machine.
Administered and facilitates reconsiderations that need to be reviewed by the appeals committees.
Provides support to Medical Analysts for needed information on bills. Allocates time efficiently, handles multiple task and efficiently process work.
Kelly Services, Feasterville, PA February 2011 to May 2011
Care Associates (Contractor Care Allies, Blue Bell, PA)
Responsibility required following proper workflow and guideline of various companies’ policy to perform verification of authorization for inpatient, outpatient, upcoming admission and surgical procedure base on medical information received from the provider or patient to obtain pre-certification for the service.
Demonstrate effective communication verbal and written to our providers, patients, benefits specialist insurance carrier to verify information pertaining to the patient; as well answers any question concerning the patient benefits to obtaining authorization for pre-certification for medical necessary service.
Healthcare Service Group Inc., Bensalem, PA October 2010 - February 2011
Housekeeping Aide (Sterling Healthcare & Rehabilitation Nursing Facility Media, PA, Part time)
Stock linen closets with amenities and supplies for room attendants; may include taking supplies directly to room attendants. Empty room attendant carts of soiled linen and trash.
Clean and remove spots from corridor walls and doors. Polish and clean mirrors, room number on guest room doors, and elevator doors.
Vacuum, sweep, and/or mop hallways, stairwells, dust, vending areas, and foyers. Flip mattresses and move furniture as assigned by supervisor.
Assists with moves, recycling, and delivery of supplies. Perform duties that involve the removal of trash and biohazard waste..
Aides in prevention of cross contamination, controlling bacteria, odor, and sustaining acceptable aseptic conditions.
Provides support to Medical Analysts for needed information on bills. Allocates time efficiently, handles multiple task and efficiently process work.
Landuaer Metropolitan Inc., Blue Bell, PA November 2009 to February 2010
Accounts Receivable Documentation Specialist
Responsibility required to perform verification of patient benefits regarding all types of insurance including Medicare, Medicaid, and follow up with all third party carriers basic on the physician prescription order received to obtain authorization for durable medical equipment and supplies.
Follow compliance elements of HIPPA, Medicare, Medicaid and other third party carriers.
Responsibility required to verify received physician prescription order to be process by logging into system with proficient.
Track and maintain order pertaining to durable medical equipment products for the location including inventory and equipment.
Participating in staff meeting and training sessions and reporting trends and issues concerning the customers.
Cardio Net, Conshohocken, PA December 2008 to July 2009
Customer Care Specialist
Job required to verify patient benefits to all types of insurance including Medicare, Medicaid and third party insurance carrier relating to answering patient question concerning coverage but not limited.
Perform data entry with minimal errors and obtain complete accuracy all missing information pertaining to physician prescription.
Collaborated with internal/external customers as necessary to resolve problems with process prescription orders.
Calculate financial data to determine customers eligibility for coverage payment.
Sponsored Cardio Net for heart monitors to increase business.
Solomon Edwards Group, Wayne, PA November 2008 to December 2008
Medical Billing Collection Representative (Contractor Quench King of Prussia, PA)
Job required to perform verification of patient benefits regarding all types of including Medicare, Medicaid and follow up with all third party carriers concerning outstanding clients accounts; as well answers any question. Duties required for reducing account receivable and increasing revenue.
Follow compliance elements of HIPPA, Medicare, Medicaid and other third party carriers. Demonstrate effective communication verbal and written to our providers, patients, benefits specialist and third party carriers pertaining to patient claims.
Retrieves and sends information to and from providers via e-fax or fax machine. Administered and facilitates reconsiderations that need to be reviewed by the appeals committees.
Provides support to Medical Analysts for needed information on bills. Allocates time efficiently, handles multiple task and efficiently process work.
Report trends and issues concerning the customers.
The Carney Group, Blue Bell, PA July 2010
Customer Service February 2006 – June 2006
Assisted in Medicare Open Enrollment programs.
Quest Diagnostics Inc., Norristown, PA October 2000 to October 2008
Medical Billing Representative
Handle all incoming calls concerning patients and clients bills. Perform job requirement to follow up with insurance carriers including Medicare and Medicaid relating to patients and clients bills .
Prepare reconciliation adjustment, apply denial, post payment, re-pricing, credit and refund to patients and clients bills.
Maintain a profile a of patients and clients accounts to reduce bad debt to increase the revenue.
Explain Explanation of Benefit and knowledgeable of medical terminology, CPT-4 and ICD9-Code, while reviewing the HCFA, UB form and scan documents or electronic claims in billing system.
Follow compliance elements and HIPPA standards.
EDUCATION
DeVry Institute of Technology – Columbus, OH Computer Information System June 1985
Philadelphia OIC – Philadelphia, PA Certification in Hospitality Management November 2011
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