Objective:
Seeking employment with a company where advancement opportunities are available.

Expertise includes:
Medical Claims Processor | Project Management | Client Relations
Medical Coding & Billing | Sales Support | Team Management
Medical Benefits Verification | Strategy Planning | Communications
Medical Claims Adjustments | Daily Balancing | Contract Maintenance

Achievements:

• Efficiently answered EOB inquiries for both subscriber and providers.
• Efficiently process medical claims adjustments/ pricing
• Efficiently met all departmental requirements for incoming calls benefit coverage verification and open enrollment
• Managed, planned and scheduled client contract and financial reviews monthly ,quarterly and annual for 20 million client portfolio
• Managed and resolved contractual billing issues
• Improved service delivery by establishing weekly calls and resolving "points of pain" internally and externally.
• Resolved and escalated implementation issues and minimized lost revenues of $1.3 million from incomplete orders

Experience

Confidential, (Dallas, TX) August 2008 - March 2010
Medical Claims Adjuster

• Claims processor and claims adjustment processing.
• Medical Coding ICD9/CPT.
• Medical Billing.
• Liaised between provider, subscriber and insurance carrier.
• Tracked and maintained daily activity and follow-up log
• Attend weekly conference calls to discuss pending claim plan of action resolution

Confidential, (Dallas, Texas)
Customer Service- Benefits Coverage Eligibility

• Answer incoming provider eligibility verification inquires
• Answer incoming provider precertification/preauthorization inquires ,gather and complete all required
• Information for processing and route to applicable department
• Proactively tracked pending precertification and preauthorization request
• Answer all incoming provider and subscriber EOB inquiries
• Weekly meeting for ongoing client updates and policy revisions and or projects
• Answer incoming subscriber open enrollment inquires

Independent Contractor (Dallas, TX)
Mental Health Claim Processor/ Medical Billing

• Managed and resolved all billing issues
• Processed electronic claims
• Collected subscriber deficiency balances
• Benefits eligibility verification
• Weekly progress reports pending billing issues
• Daily management and review of EOB's
• Maintained financial revenue reports

Confidential, (Richardson, TX) November 1991 - July 2007
Client Service Consultant, National Accounts Sales Support

• Point of contact for 1.5 million client portfolio contract maintenance
• Submit product service request(s) to Order Entry and Provisioning for ATM, Frame Relay, private line, voice and data circuits, ISDN, DS0, DS1, DS3, OC3, OC12 and Ethernet services.
• Attend weekly conference calls to discuss project and contract commitment fulfillment status
• Liaised between sales representative client, field technicians and order entry, collections
• Tracked milestones
• Escalated implementation issues
• Weekly and monthly client onsite visits
• Tracked all client sales and billing related services
• Managed tracked and resolved all contractual billing issues within a timely period

Confidential, (Richardson, TX)
Account Executive, Global Investments 1995-2005

• Submitted Orders to appropriate Order Entry Centers
• Proactively tracked orders
• Escalated past due milestones
• Weekly customer visits and conference calls
• Weekly status reports
• Managed customers install projects (Kintesu KWE, Mobil/Exxon, BP-Oil, and Kerr McGee)

Confidential, (Los Collinas, TX)
Account Representative, Internet International Wholesale Accounts (1994-1995)

• Managed international internet resale 3.5 million monthly client base
• Weekly project management progress reports
• Liaised between sales representative client, field technicians and order entry, A/R collections
• Tracked milestones
• Submit product service implantation request to Order Entry
• Tracked all client sales and billing related services
• Managed tracked and resolved all contractual billing issues within a timely period

Confidential, (Dallas, TX)
Order Entry 1992-1994

• Submitted Orders to appropriate Order Entry Centers
• Processed orders for ATM Provisioning , Frame Relay, private line, voice and data circuits, ISDN, DS0, DS1, DS3, OC3, OC12 and Ethernet services.
• Proactively tracked orders
• Escalated past due milestones
• Weekly customer visits and conference calls

Confidential, (Dallas, TX)
Customer Service Call Center Team Lead 1991-1992

• Answer high volume incoming residential product service calls and maximized savings for customer calling plans
• Answered high volume incoming residential billing calls and provided timely billing resolutions issued applicable credit adjustments when warranted
• Proactively tracked pending , customer call backs and follow-up billing issues
• Point of contact for escalated customer call backs
• Managed lunch schedule

Education
Bachelor of Science

Technical Skills
Systems - Microsoft Windows 97, Microsoft windows Office Suites - XP 2007; Microsoft Office - Microsoft Excel, Access, PowerPoint, Word, Outlook, and Internet Explorer, Seibel, Quick Books, Electronic Claims
Processing software, Medical Billing software, Telecommunications Implementation and Billing Software applications