Customer Service, Data Entry Representative. Medical Claims

EDUCATION

Troy University, Dothan, AL

Bachelor of Science Degree, Social Science and History Minor, March 2009

SUMMARY OF QUALIFICATIONS

•Amazing ability to coordinate work promptly and accurately

•Strong interpersonal communication, leadership and customer service skills

•Ability to type a minimum of 40-50 words per minute

•Proactive “doer” able to identify problems, finds solutions, and face challenges head-on.

•Quick and eager to learn; conscientious and detail-oriented.

PROFESSIONAL BACKGROUND

Nemours, Jacksonville FL 06/2011-Present

Hospital Reimbursement Specialist

•Responsible for serving as lead and specialist in the performance of account adjustment/reimbursement activities.

•Perform data downloads, imports, and otherwise updates systems, calculates and reconciles contractual adjustments required for government payors.

McKesson Corporation, Jacksonville, FL 03/05-06/2011

Medical Insurance Specialist

•Responsible for entering patient demographics and insurance information from emergency room physician charts and attached copies of insurance cards for payment by insurance companies.

•Maintain and exceed daily goal.

•Maintain quality of 94%

Zurich Insurance Service, Jacksonville, FL 05/2004-03/2005

Direct Bill Service Representative

•Answer calls from Agents and Policy holders regarding account status and billing questions.

•Provide account breakdown to determine if the account is billing correctly.

•Assist In-house Agents with general questions on policies.

•Maintained goal of 60-70 calls daily with Service Level goal of 81%

Principal Financial Group, Jacksonville, FL 05/1998-03/2004

Senior Customer Service Representative

•Answered questions from providers and policyholders regarding medical bill status and payment.

•Transfers calls to the appropriate departments

•In charge of generating Customer Response & Resolution (CR&R) for providers and policyholders with medical billing and reimbursement related issues.

•Performed follow-up on Customer Response & Resolution forms to ensure completion

•Maintained goal of 90 calls daily with procedural quality of 100%.

Claims Examiner

•Responsible for independently managing a caseload of medical, vision and dental claims within a computer-based environment using Facets.

•Performed functions related to the claims payment process requiring me to utilize a high degree of independent judgment in decision-making.

•Interpreted and applied policy provisions for the self-funded, and company policies and procedures.

•Maintained goal of 95 claims paid daily with combined procedure/dollar quality of 100% legally compliant in accordance with plan provisions as well as state and federal laws.

•Promoted within the company to Senior Customer Service Representative holding the position of Claims Examiner for 2 years

Data Entry Operator

•Responsible for manually entering medical, dental and vision claims.

•Maintained daily goal of 180 claims entered daily

•Maintained combined procedural/dollar quality of 100%

•Promoted within the company to Claims Examiner after 1 year of holding the position of Data Entry Operator.

COMPUTER SKILLS

MS Excel, MS WordPerfect, MS Word, MSPowerPoint, Lotus and Outlook

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