Customer Service Representative
Resume:
Arnita Clark
Cambria Heights, NY 11411
********@*****.***
Education
Norfolk State University, Norfolk, VA, Bachelor of Science in Exercise Science
Work Experience
Northshore LIJ Franklin Hospital September 2004-2012
Valley Stream, NY
Registrar
• Served as coordinator for the admissions, transfers and discharges of patients.
• Reviewed with the appropriate personnel the anticipated bed requirements for each shift.
• Coordinated the transfer of medical records and laboratory results with patients who are sent from other institutions.
• Interviewed patients and prepared admitting charts.
• Supervisor of the Admitting Department on the overnight shift.
• Explained admitting procedures to the patients.
• Acted as a liaison between the physicians and various hospital departments.
• Completed death certificates.
HealthCare Partners, IPA October 2001-2008
Garden City, NY
Customer Service Representative/Provider Relations Representative
• Responsible for assisting HIP and HCP health plan members and physicians with issues related to eligibility, credentialing, and claims.
• Responsible for preparing monthly finance reports using Excel.
• Worked closely with the credentialing department in obtaining information from providers.
• Initiated and maintained strong, positive working relationship with physicians and office staff, solving problems in an effective, expedient manner and meeting their needs to increase satisfaction.
• Knowledge of capitation, physician office operations and the effect of managed care on a physician’s practice.
• Demonstrated marketing and customer relations’ skills to interact with physicians, and their office staff to maintain high satisfaction.
• Ability to interact effectively with unhappy or dissatisfied customers/constituents.
• Ensured all callers received exceptional service through dedication and professionalism.
• Answered incoming calls in a fast paced, high volume environment with accuracy and efficiency.
• Accountable for resolving claims, eligibility, authorization and other related inquires from providers, members and health plan representatives with follow-up.
• Accessed on-line member and provider information through EZ CAP.
Emblem Health June 2004-2006
(Formerly known as HIP Health Plan of NY)
Grievance and Appeal Coordinator
• Provided written acknowledgment of all member and provider correspondence.
• Conducted thorough investigations of all member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities.
• Interfaced with HIP departments, Delegated Entities, Medical Groups and Network Physicians to ensure timely resolution of cases.
• Prepared written responses to all member and provider correspondence.
• Monitored daily and weekly pending reports and personal SAWS work lists, as well as made necessary follow-up calls to internal and external entities to ensure that cases were completed on or before the applicable timeframe.
• Classified and coded Feedback Tracking (FBT) inquiries appropriately, and entered all actions taken in investigation for the auditing and reporting purposes.
• Prepared cases for medical and administrative review.
• Prepared case narratives which included the chronology of events for all completed files.
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