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Customer Service Specialist Resume

TECHNICAL SKILLS:

  • Medical Terminology
  • Help Desk
  • VoIP
  • Remit Advice
  • Accounts Receivable
  • Conflict resolution
  • MySQL
  • CPT, ICD 9
  • Telephone Application
  • Quality Assurance
  • Outbound/Inbound calls
  • AS400
  • Outlook/MS Exchange
  • PC & MS Office proficient
  • Payment Posting
  • PeopleSoft
  • Virtual - based customer service
  • Third-party Service
  • Technical Support
  • Call Center
  • Customer Operations
  • Problem Solving Skills
  • 45wpm
  • Billing/Collections

PROFESSIONAL EXPERIENCE:

Confidential

Customer Service Specialist

Responsibilities:

  • 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
Confidential, Alpharetta, GA

Claims Auditor

Responsibilities:

  • 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
Confidential, Alpharetta, GA

Claims Adjuster

Responsibilities:

  • 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
Confidential, Alpharetta, GA

Claims Auditor

Responsibilities:

  • 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
Confidential, ATLANTA, GA

Customer Service Agent

Responsibilities:

  • 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.
Confidential, NORCROSS, GA

Collection Specialist

Responsibilities:

  • 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.

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