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Click here or scroll down to respond to this candidateCandidate's Name
Street Address * Cell PHONE NUMBER AVAILABLE * EMAIL AVAILABLEExperienceConduentAugust 2011 February 2022 Benefits Customer Service Specialist Cherry Hill, NJ Answer and respond to incoming calls from employees and former employees with questions about their benefits, premiums and payroll issues. Provide information and resolve any issues pertaining to calls in a timely, courteous and professional manner. Track and log all transactions performed related to human resources and or benefits processes. Follow up on outstanding issues to ensure resolution, keep the caller informed on the status of research and close out cases when completed. Assist with Cobra enrollment for employees no longer active with employer. Assist with processing of FSA claims and assist employees with setting up Pension benefits due to retirement. Cigna Government ServicesDecember 2009 - April 2010 Customer Service Agents Denison, TX Review new enrollments for the PFFS Plan with Cigna Healthcare as a Medicare Replacement Plan to Medicare. View locations, premiums, claims and resolve member issues within the plan.Blue Cross of MissouriAugust 2008 - May 2009 Claims Adjuster Cape Girardeau, MO Reviewed and corrected denied claims resubmitted by providers of service. Viewed ICD-9 or Hcpcs codes submitted on claims for reprocessing. Pricing also reviewed for provider submitting rebilling due to charge changes. Once claims reviewed, forward for processing thru Facet system for issue of payment, if no issue of payment created letter to provider of explanation as to explain means of processing. Blue Cross of CaliforniaDecember 2005 - April 2008 Customer Service Representative Newbury Park, CA Resolved benefits and claims issues with Blue Cross insured members. Discussed provider and claim issues, worked with ppo and hmo members. Assist with helping members locate primary care providers contracted with their hmo plan, members were with a group plan thru their employers. Worked individual plans to discuss rate increases, enrollment, change of plan and payment options. Added or termed members from policy with proper information request for this process. Payment options discussed with members to pay by credit card or check by phone. Account receivable needed to balance and resolve matters on members individual plan when there was a current balance issue.EMORY HealthcareApril 2003 - December 2005 Recovery Specialist Decatur, GA Effectively work insurance denials, research & resolve denial reason found on EOB's from payers. Worked with all payers such as Medicare,Medcaid, PPO's, POS, HMO's, Commercial & Medicare Hmo replacement plans. Calls to payer to resolve denial for reprocessing of claims for additional pmyts or full pmyts. Update current & termed payers on patients accounts. Work self pays before being forwarded to Collections. Training new employees on job descriptions. Lower monthly Receivable by 85-90%. Atlanta Cancer CenterNovember 2001 - February 2003 Patient Account Rep Atlanta, GA Follow up on unpaid claims from insurance payers. Main duties was to clean up overpayment of patients accounts, file 2ndry claims with primary EOB's attached. Worked Medicaid claims and clears up Pre-cert issues pending for processing. Georgia WheelchairAugust 1999 - August 2001 Patient Account Rep Atlanta, GA Collections on past due accounts, called Insurance carriers for payment status. Resolved account to final zero. Lowered A/R by 95%. Trained & supervised temp employees on collections.Education Camden County College Associates Business Summary Demonstrates the use of Microsoft Word, MS Excel, Medical Manager, IDX, SSI, Call Brower, Mainframe, & WGS. Knowledge of insurance submission, electronic billing, collections & accounts Receivable. Detail-oriented implementing time management skills& exceptional written, oral, and interpersonal skills. Implements all aspects of managed care products including but not limited to ICD-9/CPT-HCPCS, HMO, PPO, and POS policies, Interprets contractual adjustments and payments through understanding EOB & COB guidelines. |
