Customer Service Medical

Derek R. Paulson

**** ******** ****** ************, ** 19143

215-***-****/Home 267-***-****/Cellular

EMPLOYMENT OBJECTIVE

To secure a position as a Follow Up Representative

PROFESSIONAL HIGHLIGHTS AND PERSONAL SKILL SETS

Enthusiastic, willing attitude; principled with strong work ethic

Ability to perform independently, or as part of a team to achieve desired goals

Aptitudes: written/oral communication; Access; Excel; WordPerfect; Microsoft Office

EMPLOYMENT HISTORY

INDEPENDENCE BLUE CROSS Philadelphia, PA 19103

Network Coordinator May 2001 – December 2011

Service over 600 contracting specialty providers in the Philadelphia and surrounding areas. Knowledge of all company lines of business (HMO, PPO, Indemnity and Medicare supplemental/ advantage products) required. Assist with credentialing and provider set-up. Perform research and analysis of issues related to claim processing and provider reimbursement. Successfully collaborates with integral and supportive company divisions in adjudicating challenging and complex claim processing elements (CPT; ICD-9; HCPCS) and Medicare processing systems for end-user and system updates. Ability to identify trends and root causes, as well as applicable claim payment and medical policies is critical.

Member Appeals Specialist October 1994 – May 2001

Responsible for advocating member’s concerns thorough member grievance and appeal processes. Working knowledge of all lines of the company’s businesses–primary and subsidiary; coverage benefits, claims processing guidelines; internal/external requirements; and preparation of written notification mandatory. Sensitivity to corporate, regulatory and governmental compliance standards required.

Claims Service Representative October 1992 – October 1994

Provided claim support to Customer Service and Marketing Divisions, as well as to other ‘Blue’ plans. Written and oral skills required.

Claims Examiner October 1989 – October 1992

Accountable for the accurate and expeditious adjudication of high-volume claim processing for all lines of the company’s business, including the research required to finalize suspended claims.

EDUCATION

Delaware County Community College, Newtown Square, PA

Graduated May 2011 - President’s Honor List (Summa Cum Laude)

Certificate in Medical Coding and Billing

University of Pittsburgh, Pittsburgh, PA

Graduated April 1988 - Bachelor of Arts in Economics - Minor: Sociology

References Available Upon Request

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