Customer Service Quality

Jazzoree Crawford

Stockbridge, GA *****

678-***-****

********@*****.***

Objective:

I am seeking a challenging position where my education, experience, communication, managerial, customer service will allow me to make an immediate and profitable impact on any medical practice I am employed with. I will welcome difficult challenges, learn new ideas, be mindful of details, and stay on top of required deadlines.

Experience

Delta Dental Insurance Company/Hire Dynamics Temp

Call Center Representative (12/10-07/2011)

• Responds to complex telephone, electronic, and written inquiries from dental/vision professionals, groups, and subscribers

• Expediently accesses reference materials to analyze and determine appropriate responses to telephone, electronic, and written inquires

• Communicates eligibility, benefits, and claims status, policies and procedures

• Documents each customer encounter and resolution in the appropriate computer tracking system and adjusts claims as necessary based upon findings

• Meets and maintains production standards, counts, and inquiry response turnaround times and reprocesses claims, as appropriate

DeltaCare Claims Backlog Project

Payments & Pre Authorization (2/11-07/2011)

• Research and sort dental claims by accessing the facility database and finding/sorting by specialty

• Sort specialties by Performance Guarantees from Normal workflow

• Key Claims by means of Matrix rules and regulations (Companies manual) and specialties

HealthLogic (Years employed 2004-2010)

Implementation Analyst/Coordinator - (1/2008 – 2/2010)

• Work closely with inbound clients calls and lockbox to understand and address the client business needs, scope, and plan for multiple projects

• Act as a Helpdesk Analyst to high priority clients.

• Database construction and maintenance of client’s internal server infrastructure

• Using the system to make sure that the balanced paid amount equals the clients’ deposit.

• Analytical activities, including assisting with the development of test plans and identify data quality resolution strategies

• Plan and execute unit, integration, and acceptance testing; and creates specifications documents for systems to meet business requirements

Team Leader – Coder (2/2006-12/2008)

• Served in a leadership role to ensure preparation for workflow changes were in place, while maintaining quality and compliance standards

• Responsible for all inpatient and outpatient coding and reimbursement activities across the integrated health system

• Educator for the coding staff and other implementation coordinators on the use of coding guidelines, documentation techniques, and functionality as it relates to quality management of clinical data

• Perform operational management of monitoring health record coding, insuring that results meet and\or exceed overall regional targets on a consistent basis

Coder (7/2004-2/2006)

• Ability to read, comprehend, and translate EOB’s onto HCFA1500 and UB04 claims in to a verification grid

• Researched, corrected, and edit rejected or denied claims

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