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Click here or scroll down to respond to this candidateCandidate's Name
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PHONE NUMBER AVAILABLEEMAIL AVAILABLECareer ObjectiveSeeking in the healthcare administration field which will utilize mydiverse experience to make a contribution to an organization's goals and provide stability and opportunity for professional growth.EducationTrinity High School: High School Diploma, 1993,Skiles Cosmetology: Cosmetologist Licensed, 1996Emdeon University: Certificate for ICD-10, 2015 and also Certificate in HIPAA, 2015Skills & AbilitiesComputer Skills: Ten-Key, Microsoft Outlook, Excel and Pivot tables, WordMedical Abilities: Verifying insurance, ordering and processing medical records, refunds, billing, collections, ICD-9 and ICD-10 knowledge, CPT and Diagnosis Codes, medical terminology, processing claims on HCFA 1500 and UB04 forms, appeals, electronic billing, Medicare, Medicaid, Star Plus, Managed Care, Private and Commercial insurance knowledge, Account Receivable, 18 years of experience with High Call volumes in Call Centers, Bevhavioral Health, Care Management, Utilization ManagementCommunications Skills: Customer service with inbound and outbound calls.Systems Abilities: Rimes (Qlink), Trizetto, Q-NXT, Insware, Aldera, EMSISystems, Invision Gold, Siemans Document Imaging, OnBase Document Imaging, Quickbooks, Athena, Citrix, Akkadian, Kronos, CPSI, EpicEmployment HistoryCustomer Service Representative -Texas Health Resources -Remotely February 2020 to February 2024I took inbound calls from patients and Providers.I explained to them how the claim was processed and went over their benefits. I collected payments. Sent claims back for reprocessing. Trained new employees. Had to meet daily and weekly adherence and available time. Had to pass monthly quality on my phone calls. Insurance Providers would call and verify if claim was processed correctly and get claim status. Answered any questions a patient would have about there claim and resolved the issue. Read EOBs. Handled 50 calls a day. Worked on claim denial reasons. Set up payment plans.Cardiac and Pulmonary Rehab Access Service Baylor Scott and White Hospital ( Contract work for Addison Staffing) Fort Worth, TX. August 2019 to October 2019 I did scheduling and admitting for cardiac and pulmonary rehab. Sent orders to the physicians for them to give the ok for patients to come to rehab. Scheduled patients for cardiac and Pulmonary rehab. Admitted patients when they came in to have surgery in the Cath Lab. Called patients to remind them of there appointment the next day. Called Insurance companies to verify Insurance and to get benefits. Collected payments for patients' responsibility. Spoke to the patients about their benefits and what would be their responsibility.Care Senior Associate Cigna Healthcare, (Contract Work) - Bedford, TX, October 2018 to January 2019Worked in the Managed Care Intake Utilization Department doing the Pre-Certification, Authorization Department. collecting, interpreting and evaluating medical information received for authorization. The Pre-cert Specialist will communicate with internal and external providers regarding authorization status. Received request for authorization from hospitals, providers, members and vendors. Meet service level goals and maintain standard turn around times. Determine authorization requirements based on company policy, member benefit grid and provider status. Review authorization requests and make determinations on correct authorization process. Process extensions of authorizations as appropriate. Processes denials including correspondence sent to families, members, facilities and providers. Notifies responsible parties prior to denial letter and ensures that member and responsible party understand details of the letter and the appeals. Completes review of non-authorized medical claims. Worked with Medicare, Medicaid and Star-Plus. HandledHigh volume of calls could be up to 60 calls a day.Insurance Collector Texas Health Resources, (Contract Work) - Arlington, TX, June 2017 to December 2017 Reviewed account for payment details, called insurance to get status of the medical claim, insure that claims were paid to contract, filed appeals on claims that were underpaid or denied, answered incoming calls from insurance companies and patients asking question about accounts, resolved outstanding line request to complete worklines, reported trends of issues to manager, reviewed and resolved request for medical records, worked correspondence from insurance companies. A/R Collections.Insurance Specialist and Collections Medical City of Dallas with Dr Jeffery Fearon, - Dallas, TX, August 2016 to April 2017 Reviewed and tracked unpaid or underpaid claims for filing accuracy, wrote appeal letters to dispute unpaid or underpaid claims, communicated with insurance companies to file verbal disputes, reviewed paid claims to Letters of Agreement to ensure payments reflect negotiated rates, communicated with families to enlist their help with resolving open claims, inform families of their financial responsibility to the claim based on coverage deductibles and out-of-pocket expenses, document all conversions and resolutions in computer operating systems, A/R collections, proactively reviewed solutions to insurance concerns and offer suggestions for resolution, assist insurance Team Lead with other insurance related projects.Claims Customer Representative Team Lead North Texas Specialty Physicians, (Contract Work) - Fort Worth, TX January 2016 to June 2016 Inbound call center for a TPA. Talked to providers and members. Gave claim status. Sent claims back to examiners to have reworked if claim did not process or pay correctly. Did claim status spreadsheets for providers. Looked up and verified referrals and authorizations. Did stop payments and reissued checks. Handled Medicare replacement plans for Care N Care, Health Team Advantage, United Health Care and Humana claims. Handled offshore accounts. Trained new employees. Handled any back office work my supervisor gave me. Made outbound calls to providers to give them claim statues and handled Escalated Phone Calls.Customer Service Representative Team Lead Valence Health, (Contract Work) - Bedford, TX August 17th 2015 - January 2016 Inbound call center and also handled back office work, talked with members and providers for assistance on verifying insurance and verifying insurance benefits, claim status or helped them with any questions they had about the insurance plan., Assisting providers with claims status and member eligibility and benefits and assisting members with payments and providers listing and questions concerning benefits., Also handled off shore accounts, Goal to assist as many members and providers in a professional and courteous manner and always taking care of the call to the fullest. Also trained new employees and took escalated calls. |
