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Click here or scroll down to respond to this candidateCandidate's Name
Minneapolis, Minnesota * Phone: PHONE NUMBER AVAILABLE * Email: EMAIL AVAILABLE Remote Patient Access Specialist Prior Authorization With over 20 years experience, I am a customer-centric professional dedicated to delivering exceptional customer support in both the retail and health information sectors. Exceptionally proficient in delivering customer support through phone calls, emails, and chat interactions. Dedicated to achieving first-call/chat resolution, excelling in fast-paced environments, and upholding strict confidentiality standards. Proficient in Microsoft Office Suite, CRM tools, and medical billing software. Demonstrating robust analytical skills, meticulous attention to detail, and an unwavering dedication to ensuring customer satisfaction.SKILLS and EXPERTISE Customer Service: Exhibits empathy, courtesy, kindness, efficiency, confidence and helpfulness in delivering excellent customer support. Bilingual Abilities: English and Spanish. Technical Proficiency: Proficient in Microsoft Word, Excel, and Access. Able to multitask across various software, including CRM tools and medical billing software. Excellent typing skills with the ability to navigate online tools and systems. Flexibility and Shift Commitment: Adaptable enthusiast with a passion for change and improvement in fast-paced environments. Ready and eager to commit to the assigned shift and training schedule, as specified in the job requirements. Communication and Problem Solving: Highly detail oriented, ability to communicate clearly and understandably, analytical, and problem-solving skills, enabling the establishment of rapport with customers and the resolution of complex issues. Organization and Efficiency: Highly organized and efficient with a meticulous eye for detail. Skilled at task prioritization and managing multiple projects in fast-paced environments. Reliable and punctual. Independence and Initiative: Ability to multitask, work independently with minimal supervision while meeting predefined production and quality standards. Embraces the unknown: Comfortable working cross functionality with other teams and working through ambiguity. Medical Billing and Coding: Proven expertise with medical claims processing, medical billing, and coding. Strong knowledge of medical terminology, anatomy, physiology, and ICD-10, HCPCS, DSM-IV coding systems. Insurance Expertise: Ability to interpret Explanation of Benefits (EOB), UB-04, and CMS-1500 forms. Experience with insurance companies, claims status, eligibility verification, and appeals. PROFESSIONAL EXPERIENCESOUTH CAROLINA MEDICAID PROGRAM, Minneapolis, MN/WFH 12/2021 01/2024 Medicaid Member Support Representative (Eligibility and Enrollment) Manages 50+ inbound calls from South Carolina Medicaid members, providing exemplary customer support in a call center environment. Provides clear and concise information regarding member eligibility, along with assisting callers with completing their Medicaid applications and providing updates on their application status. Overall, acts as an advocate for Medicaid members to ensure their needs are met. Utilizes multiple applications and platforms to manage calls. TARGET, Minneapolis, MN/WFH 10/2020 12/2021Guest Services Online Chat and Call Center Rep Addressed 50+ inbound calls, online chats, and emails from Target's guests, resolving service or billing complaints and assisting with orders. Maintained current knowledge of sales, promotions, payment policies, and security practices. Utilized Salesforce and proprietary software.COMMUNITY UNIVERSITY HEALTHCARE CENTER, Minneapolis, MN/WFH 12/ 2019 10/ 2020 AR Medical Billing Specialist (Contracted) Collaborated with insurance companies to ensure accurate and timely billing, achieving optimal reimbursement for medical, dental, and mental health services at a Federally Qualified Health Center (FQHC). Prepared and submitted claims, proactively tracked and followed up on unpaid or denied claims, and initiated appeals when necessary, resulting in improved revenue collection. Leveraged payer websites proficiently for claims status checks, eligibility verification, and benefits assessment, streamlining billing processes. Generated aging accounts receivable reports, using Microsoft Excel and Epic Ochin for effective follow-up on outstanding accounts.ALLINA HEALTH, Minneapolis, MN/WFH 10/2017 11/2019 Patient Account Resolution Specialist (PARS) Provided efficient resolution and excellent customer support for hospital and clinic patients, managing 50+ inbound calls from patients with unresolved accounts. . Assisted patients with inquiries about charges, payments, and collections, offering financial counseling and guidance to uninsured and under-insured individuals. Processed patient payments through Ability SecurePay and Epic Excellian systems, simultaneously updating patient demographics and insurance coverage. Analyzed insurance coverage using Healthia and other payer websites, determining patient responsibility, and initiating claims resubmission when required.UCARE, Minneapolis, MN 09/2015 10/2017Member Services Representative Managed 50+ inbound calls from members, providers, internal departments, and external agencies, delivering prompt and accurate information on members' healthcare programs and ensuring high-quality customer support. Educated members and external customers on policies and procedures related to membership, health plans, and benefits. Resolved inquiries regarding enrollment, eligibility, ID cards, clinic changes, benefit coverage, claims, payments, and member reimbursement, ensuring customer satisfaction. Utilized payer websites effectively to interpret member eligibility and coverage, demonstrating a strong understanding of contracts, policies, and procedures.COMMUNITY UNIVERSITY HEALTHCARE CENTER, Minneapolis, MN/WFH 11/2015 Present Medical Billing Specialist (Per Diem) Reviews and validates assigned diagnosis and procedural codes for accuracy, ensuring proper reimbursement of medical claims. Communicates with physicians to obtain clarifications for accurate coding according to guidelines and regulations, maintaining precise coding practices. Utilizes information systems and web-based tools to facilitate proper reimbursement of provided services, contributing to revenue optimization.OPTUM HEALTH, Minneapolis, MN/WFH 05/2013 08/2015 Senior Customer Service Representative Efficiently handled 80+ inbound calls and 10+ emails daily from physicians, providing comprehensive support related to members coverage and addressing inquiries about claims eligibility, statuses, verification of benefits, and prior authorizations. Collaborated with billing and eligibility representatives to resolve complex customer service inquiries, serving as the primary interface for physicians. Aided with verification of benefits, prior authorizations, enrollment, and answering questions related to insurance benefits, ensuring physician satisfaction. Conducted updates to patient demographic and insurance data, as well as process member terminations with accuracy and attention to detail. Utilized Facets and proprietary software.UNITEDHEALTH GROUP, Minneapolis, MN/WFH 04/2012 04/2013 Senior Data Entry Specialist Created a new Access database by migrating data from an Excel spreadsheet. Conducted manual review of over 80,000 records from an old database, extracting specific member information and accurately entering it into a new Excel spreadsheet. Developed an Excel spreadsheet with well-defined criteria for efficient data entry in each field. Transferred the cleaned and organized data from the old database to the new Excel spreadsheet. Generated and ran reports to validate and ensure the successful import of data into the new Access database. Created a new Access database, adhering to predefined criteria, and seamlessly imported the data from the Excel spreadsheet.EDUCATIONSAINT PAUL COLLEGE, St. Paul, MN Associates of Science in Health Information Technology 01/2012 05/2013 Certificate in Medical Billing and Coding 08/2009 12/2011 |
