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Click here or scroll down to respond to this candidateCandidate's Name
Cleves, OH Street Address
Contact PHONE NUMBER AVAILABLE EMAIL AVAILABLEPROFESSIONAL PROFILECustomer service oriented professional with vast hands-on healthcare industry experience, capable ofensuring smooth patient flow by providing prompt attention to pulling patient charts and necessarymedical records. Gathers accurate billing and financial information and reviews intake materials foraccuracy and completeness. Reviews ICD-10 codes and CPT codes for accuracy before submittingmedical claims for reimbursement. Extensive knowledge of Claims Life-Cycle and Revenue CycleManagement. Simplifies health insurance so that the patient is educated on how their claims are paidfor services rendered by a healthcare provider or healthcare facility, by providing detailed explanationof their EOB. High level of knowledge with CMS guidelines with DSNPs, or Dual Eligible, LIS,Medicaids Low- Income Subsidys, and MCOs, or Managed Care Organization. Vast knowledge ofCMS Guidelines for Medicare and Medicaid in various states including, OH, KY, FL, IN, DE, WI, MI, GA,NJ, TX, MO, IL, and TNAccustomed to a fast-paced call center environment, handling up to 100 plus calls a day in an 8hour shiftStrong understanding of the importance of accurate claims processingAttention to detail needed to review and correct errors and maintain high levels of accuracyMicrosoft Office Applications / MS Excel MS Word MS PowerPoint MS Outlook Microsoft365 TeamsComputer Software: Member 360 CSA Streamline E-scripts Allscripts Bonafied BrightreeOmni Finesse True Care & TrueCare Cloud Genesys and Genesys Cloud Facets MultipleBilling and Coding software and platformsTyping Speed: 65 WPMKEY QUALIFICATIONSMedical Practice Management Systems Medical Terminology Medical Records HIPAAComplianceInsurance Verification Insurance Claim Processing Reimbursement Processing Revenue CycleManagementMedicare Medicaid Government Payers Third Party Payers CPT & ICD-10 CodingMedical Billing Medical Office Medical Administrative Patient Registration Data EntryPharmacy Prior Authorization Benefits & Eligibility Explanation of BenefitsCoordination of Benefits Utilization Management Time Management Commercial PayersEDUCATIONUltimate Medical Academy Associate of Science Degree Health Sciences Medical Office andBilling Specialist, 2022Ultimate Medical Academy HIPAA Essentials for Healthcare Professionals CertificateCertified Billing and Coding Specialist Enrolled in Google Data Analytics Certification throughCoursera Academic Recognition Honor Roll January 2021- Deans List Award March 2021PROFESSIONAL EXPERIENCEBswift10/09/2023-11/20/2023Service Center AgentCandidate's Name Cont.Utilized multiple systems and screens to verify member information and research issues to providesolutionsProvided excellent customer service in an inbound, fast paced, high volume call center to enrollmembers during Open SeasonCentene Corporation- Meridian Medicaid MI Farmington, MO 04/2023 08/2023Member Services RepresentativeUtilized multiple systems and screens to verify patient information and research issues to providesolutionsProvided excellent customer service in an inbound call center for Meridian Medicaid Michigan MembersResolved issues and answered questions regarding DSNP, LIS, and MCO membersVerified Benefits & EligibilityVerified ICD-10, HCPCS, and CPT codes were accurate and billable per plan policyExceeded quality expectations and performance goals set by Workforce ManagementCigna Health GroupKansas City, MO 08/2022
04/2023Utilization ManagementUtilized multiple systems and screens to verify patient information and patient charts.Organize and collect data for the billing sheet and submit data entry daily.Make the patients information match up to the corresponding encounter sheet.Assisted physicians offices, healthcare facilities, hospitals, and pharmacies with obtaining priorauthorization for upcoming procedures and services, inpatient hospital stays, and outpatient services.Verified Benefits & EligibilityVerified ICD-10, HCPCS, and CPT codes were valid and billable per plan policyVerified if members were part of DSNP, LIS, or MCO plans for various states including Michigan,Delaware, Ohio, Kentucky, Indiana, and FloridaAdvanced knowledge of Medicare and Medicaid guidelines for various states that includes, Michigan,Delaware, Ohio, Kentucky, Indiana, and FloridaAnthem Federal Cincinnati, OH 07/2021
04/2022Claims Customer Service RepresentativeEnter medical codes, answer inbound phone calls, and help members enroll into patient portalsAdvise callers of benefits and eligibility for medical services to be performed, as well as advising ofcopays, coinsurance, deductibles, out of pocket maximums, total costs, and whether services requireprecertificationAdvise members on the status of their healthcare provider and mail out plan brochures and memberidentification cardsDemonstrate professionalism, critical thinking, effective communication, cultural competence, andinterpersonal skillsIngenioRx Mason, OH 11/2020
03/2021Customer Service RepresentativeProvided exceptional customer service to members, healthcare providers, hospital staff, pharmacists,and skilled nursing facilities with obtaining prior authorization for prescription medicationsWent above and beyond what was expected in order to assist more than 100 callers per day thatneeded to fill prescriptionsUtilized critical thinking skills, actively listened to callers, and entered medical codesVerified if members were part of DSNP, LIS, or MCOCandidate's Name Cont.Verified and updated Coordination of benefits, or OHIMullaney's Pharmacy and Home Health Cincinnati, OH 02/2020
07/2020Customer Service RepresentativeTrained new hires, entered medical codes, and assisted customers entering the storeProvided support to all 5 Mullaney's stores by traveling to their location to provide coverage when thestore was short staffedProcessed prescriptions for medical equipment and supplies and answered inbound phone callsOperated multiple software programs, obtained supporting documentation, and prepared ordersVerified if patients had OHI, COB, DSNP, LIS, or were part of an MCOAdhered to CMS guidelinesMedisync Cincinnati, OH 05/2018 11/2019Patient Account RepresentativeReprocessed claims, entered medical codes, and trained new hiresProvided exceptional customer service to more than 100 callers per day in a medical billing call centerDemonstrated critical thinking, effective communication, organizational, and interpersonal skills whenassisting patients who had questions concerning their explanation of benefits for recent office visits withtheir healthcare providerSet up payment plans for patients with high balances and who were in collections for past due balancesLed team building exercises in order to obtain payments on aged collection accountsTrained new patient accounts representatives on the software the department used to look up patientaccounts, software used to process payments over the phone, and call coaching when taking calls frompatient's calling into the call centerActed as liaison between the health care provider and patients if there was a complaint with the medicalofficeProcessed self-pay refunds on patient's accounts if there was a credit balance due to the patientVerified and updated COB, OHI, DSNP, LIS, or were part of a MCOBernens Cincinnati, OH 07/2016
04/2018Customer Service RepresentativeAnswered inbound phone calls, maintained inventory levels, and ordered suppliesEntered medical codes, verified insurance, accepted payments, and called in referralsTrained new hires, upsold items, enrolled new members, and completed end of day paperworkVerified Benefits & Eligibility and obtained prior authorization for medical equipment and suppliesthrough health plan if necessaryVerified ICD-10, HCPCS, and CPT codes were valid and billableVerified if patients were part of DSNP, LIS, or MCOWe Care Medical Somerset, KY 04/2013 06/2016Site CoordinatorOrdered inventory, trained new employees, and entered medical codesDispatched delivery drivers, handled new patient intake, and verified Benefits & EligibilityAcquired prior authorizations, updated demographic information, and utilized Brighttree to scheduleappointmentsVerified OHI, verified and updated COBVerified if patients were part of DSNP, LIS, or MCOsCandidate's Name Cont.LinkedIn profile http//:LINKEDIN LINK AVAILABLEReferences available upon request |
