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| | Related Resumes Customer Service Client Columbia, SC Customer Service Quality Assurance Columbia, SC Customer Service, Call Center, Multi Tasker, Research, Investiga Gilbert, SC Customer Service General Maintenance Santee, SC Customer Service Agent Aiken, SC Customer Service Travel Consultant Ehrhardt, SC Customer Service Human Resources Columbia, SC |
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Click here or scroll down to respond to this candidateCandidate's Name
Columbia, SC Street Address USSkillsBilling & CodingMedicare AdvantageCernerPayment postingMedicaidCustomer & Client ServiceOffice ManagementData AnalysisCMS Guidelines & PracticesEpicMicrosoft Office Suite (Word, Excel, Outlook, PowerPoint, Teams), Workday, SalesforceEducationHigh school Diploma, Loris High School, Loris, SCDiploma Medical Billing and Coding, Ultimate Medical Academy, Tampa, FlProfessional experienceBanner health- Phoenix, AZ 03/2023-9/2023Grievance and Appeals CoordinatorAnalyse, investigate and resolve appeals, complaints, and grievances associate to claim events to establish what the companys liability and entitlement will be.Blue Cross Blue Shield - Columbia, SC 01/2023-3/2023Claims Customer Service AdvocateProvide prompt, accurate, thorough, and courteous responses to all complex inquiries from Medicare Advantage members and providers.Perform research as needed to resolve inquiries.Review claims or appeals issues, complaints, and inquiries referred by Member Service Reps.Maintain accurate records concerning issues.Follow through on complaints until resolved or report to management as needed.Sends out benefit enrollment packets to all newly eligible members.Blue Cross Blue Shield - Columbia, SC 09/2022-12/2022Senior Client Service RepresentativeProvide prompt, accurate, thorough, and courteous responses to all complex inquiries from Medicare Advantage members and providers.Perform research as needed to resolve inquiries.Review claims or appeal.ls issues, complaints, and inquiries referred by Member Service Reps.Maintain accurate records concerning issues.Follow through on complaints until resolved or report to management as needed.Sends out benefit enrollment packets to all newly eligible members.Order ID cards, Track and process all new member benefit enrolments.Highmark Health, Columbia, SC 01/2022-9/2022Claims Customer Service AdvocateReview patient records and policy requirements.Process and adjust claims meeting daily productivity.Maintain daily and direct communication.Work professionally and with due diligence and be expeditious to meet quality and production requirements.Maintain the highest standard of customer service including professionalism, courtesy, patience, and respect.Blue Cross Blue Shield -Columbia, SC 09/2019-01/2022Claims Processor IIReview patient records and policy requirements.Process and adjust claims meeting daily productive/verify enrollment and benefits.Provided prompt, accurate, research thorough professional communication to resolve complex customer inquiries/ issues.Backend ReportsPrice Cooper -Columbia, SC 08/2018-9/2019Patient Service RepresentativeReview patient records /claims to identify and correct errors.Document, access, organized, claims using Epics system and various software.Communicate with hospital representatives, insurance companies, and internal team members to resolve claims and collect payment effectively and efficiently.Creating/updating/managing spreadsheets. Process open enrollment benefit plan transfers / Maintain patient benefit files and record keeping.Blue Cross Blue Shield -, Surfside, SC 06/2014-4/2018EDI Operations Associate IProcessed EDI claims and patient records to ensure accurate data posted, set-up requests and managed logs and supporting documents for back up.Processed and tracked electronic funds transfer for providers. Reviewed daily EDI rejection; research and identified root causes and served as liaison between internal and external teams for appropriate and timely corrections.Provided prompt, accurate, research thorough professional communication to resolve complex customer inquiries/ issues.Performed varied clerical office duties, in accordance with standard procedure.Professionally trained in Records Management.Prepare reports from different databases utilizing access per request of the internal teams, attorneys, and vendors based on business needs.Blue Cross Blue Shield - Surfside, SC 07/2013-06/2014Data Prep Tech IPerformed varied clerical office duties, in accordance with standard procedure.Professionally trained in Records Management.Prepare reports from different databases utilizing access per request of the internal teams, attorneys, and vendors based on business needs.Created reports and analyse data to make recommendations and improvements within department. |
