- Medical Terminology
- Help Desk
- Remit Advice
- Accounts Receivable
- Conflict resolution
- CPT, ICD 9
- Telephone Application
- Quality Assurance
- Outbound/Inbound calls
- Outlook/MS Exchange
- PC & MS Office proficient
- Payment Posting
- Virtual - based customer service
- Third-party Service
- Technical Support
- Call Center
- Customer Operations
- Problem Solving Skills
Customer Service Specialist
- Empathized with and prioritized every customer’s needs with respect and patience while showing ownership and upholding company values.
- Answered and managed incoming and outgoing calls while recording accurate messages
- Fluent in Windows Operating System and Microsoft Outlook Accustomed to using multiple browsers, multiple tabs and window navigation, and instant message tools.
- Resolved product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution
- Approached problems logically and with good judgment to ensure the appropriate customer outcome.
- Documented customer account activities thoroughly and concisely.
- Gained experience working with customer from different ethnicities.
- Understood the importance of managing sensitive member information with integrity
- Reviewed claims and coded treatment procedures using Common Procedure Terminology (CPT) codes
- Reprocessed underpayments, appeals denials and turns them into payments, ensures accurate reimbursement on all claims
- Audited accounts for proper payments, coding, balances, adjustments, etc. using appropriate reports andwork queues to do so.
- Translated dental procedures into codes that can be translated by payers, other medical coders, and other medical facilities
- Complied with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.
- Medical billing and collections
- Made calls and answered customer questions, issues and complaints
- Completed and submitted Medicare and Medicaid hospital billing claims to primary and secondary insurance claims
- Submitted medical appeals to the insurance providers
- Applied provider payments on accounts, applied contractual managed care reimbursement rates
- Responsibilities included posting patients’ accounts, initiating patient’s insurance claims and follow-up and unpaid and denied claims with the facets workflow system.
- Review claims for necessity, limitations, and exclusions base on claim policies and procedures
- Worked with debtors to establish patient financial services to ensure accurate and timely billing and collections from third party payors and patients
- Processed insurance claims, and entered information needed for payment.
- Exceeded requirements for daily production needed.
- Verified and analyze procedure codes used on claims to valid and process claims within the company’s guidelines.
- Reviewed of insurance carrier processes and procedures and claim handling in accordance with the National Association of Insurance Commissioners (NAIC)
- Research and process claims according the processing guidelines and benefits
- Knowledge and use of ICD-9, ICD-10 and CPT coding
Customer Service Agent
- Provided education to pharmacist for over 40 products and services offered through RelayHealth. Provided superior customer service by resolving customer issues and communicating escalated issues to the appropriate departments.
- Utilized high proficiency with both industry and proprietary software applications to resolve technical issues.
- Guaranteeing HIPAA compliance by securing enrollment and controlled access to state government regulated reporting programs.
- Provided training to the pharmacist for over 40 products and services offered through Relay Health. Contributed to team success by providing after-hours customer service work from home.
- Contributed to the success with departmental SLA's by efficient utilization of the SalesForce.
- Managed and worked batch error reports, which allowed the correction of payments and reimbursements for the amounts to be correctly distributed to the payers and or patients.
- Organized and managed guidelines on spreadsheets used by different department personnel for verifying steps and procedure .
- Performed various duties relating to priority work requested from management and co-workers in order to complete task in a timely manner.
- Successfully worked with external auditors to achieve favorable results on audit accounts for quarterly reviews
- Maintained and submitted all annual charitable write-offs to the State for company compliance.
- Provided account maintenance for patient’s accounts to identify actions taken on the Charity database. Delivered assistance to internal and external customers inquiring about medical statement.
- Handled patient questions pertaining to their current or past due account balance.
- Managed primary, secondary, VA and worker’s comp reimbursements claims for patient’s insurance companies. Resolved coding and billing problems from EOBs and corrected errors in a timely manner.
- Retrieved all patient financial and demographic records in order to close-out an account within designated time frames.