jessica claire montgomery street san francisco ca 94105 555 4321000 resumesampleexamplecom professional summary experienced customer service representative 10 years experience worked healthcare industry 8 years humana passport excellus bcbs ny successfully trained seasonal associates open enrollment worked client subject matter expert shps inc skills hcpcs coding guidelines understands anesthesia coding insurance collections procedures understands insurance benefits drg pc grouping ambulance coding familiarity composed professional demeanor research data analysis resourceful reliable worker excellent problem solver close attention detail medical terminology expert billing collection procedures expert office support phones faxing filing excellent verbal communication adept multitasker office support phones faxing filing fast learner records management professional icd10 international classification disease systems familiar commercial private insurance carrier insurance collections procedures drg pc grouping understands insurance benefits ambulance coding familiarity composed professional demeanor research data analysis excellent problem solver office management professional close attention detail excellent verbal communication work history 082016 112016 claims subject matter expert mclaren health care sterling heights mi worked special projects assigned management responsible meeting claims production goal 200 claims per day processed professional hcfa 1500 ambulance anesthesia labs office visits etc professional hcfa 1500 responsible claims processing medicaid plans hmo 7 university health hmo 9 ahcss worked claims subject matter expert banner health 042016 082016 benefit plan adminclient service expert aaa southern california eastvale ca responsible duties support departmental efficiencies assigned management scheduled refills per patients plan benefit keyed orders sent fulfillment processed rx refills customers assisted outbound calling providers patient pharmacies obtain additional info need process rx refill answered incoming calls 062015 022016 patient access rep aaa southern california el cajon ca responsible duties support departmental efficiencies may include limited performing scheduling registration patient pre admission admission reception discharge functions verify medical benefits eligibility payers calculate patient liability collection amounts completes whole patient financial clearance process including educating patients liability collection patient liabilities due completes account documentation enters correct activity code required secures insurance authorizations services updates account accordingly performs payment reconciliation secured payment entry adherence financial cash control policies procedures 062015 062015 claims subject matter expertdst jacobson solutionsinsurance consultants city state worked claims examiner dst solutions based delaware responsible processing commercial medicare plans adjusted backlog claims using clients claims system adjudication knowledgeable citrix platform applications utilized claims matrix determine authorization delivery well baby newborn inpatient claims nursing home etc 062014 042015 claims examiner first source solutions city state worked claims examiner client kaiser permanente southern california responsible data processing incoming hospital ubs medicare kpsa plan contract interpretation validate proper payment logic claim adjudication identify billing coding errors submit documentation providers necessary corrected claims forms sent medicare compliance guidelines adjudicate replacement late charge claims etc accordingly per clients guidelines processing proficient microsoft word excel power point outlook internet explorer cms pricers drg calculator icd9 cpt basic office systems various web applications 042013 042014 claims subject matter expert jacobson solutionsinsurance consultants city state worked contracted claims expert excellus bcbs ny responsible claims processing home commercial medicare medicaid plans worked special projects assigned management processed claims host side plan updating provider files credentials support claims adjustment 022008 102012 provider claims service unit representative passport health plan inc city state responsible immediate responses incoming provider calls regarding claims issues process incoming correspondence providers claims issues need resolved passport health medicaid passport advantage reprocessing claims identified incoming phone calls submitted provider relations staff identifying systematic procedural issues resulting claims processing errors initiating action resolve issues documenting calls problems resolutions future reference proficient microsoft word excel power point outlook internet explorer facets ika systems cms pricers drg calculator icd9 cpt basic office systems web application worked special projects assigned management 042004 022008 benefits plan administration eligibility enrollmentclient service expert shps inc city state answered incoming calls regarding eligibility claims processing billing inquires administered employee group benefits retirees active long term disability cobra participants resolved issues billing carrier eligibility etc organized special projects web inquiry responses updating accurate information knowledge base customer service tool assigned management team leadinitiated training fulltime temporary associates ongoing call center open enrollment 032001 012003 customer service claims specialistchicago medicare commercial medicaid humana inc city state supported chicago medicare medicaid commercial markets received inbound outbound calls insured members clients brokers agents providers mailed related correspondence enrollment material forms brochures members processed medical claims needed adjustment knowledgeable drg icd9 cpt coding managed customer calls effectively efficiently complex fastpaced challenging call center environment accurately documented researched resolved customer service issues managed high call volume tact professionalism acted professionally patiently addressing negative customer feedback resolved service pricing technical problems customers asking clear specific questions effectively managed highvolume inbound outbound customer calls 062014 042015 claims examiner firstsource solutions outsource bpo city state worked claims examiner client kaiser permanente southern california responsible data processing incoming hospital ubs medicare kpsa plan contract interpretation validate proper payment logic claim adjudication identify billing coding errors submit documentation providers necessary corrected claims forms sent medicare compliance guidelines adjudicate replacement bill type late charge claims etc accordingly per clients guidelines processing proficient microsoft word excel power point outlook internet explorer cms pricers drg calculator icd9 cpt basic office systems various web applications precisely completed appropriate claims paperwork documentation system entry thoroughly researched newly identified diagnoses andor medical procedures expand skills knowledge resourcefully used various coding books procedure manuals online encoders actively maintained current working knowledge cpt icd9 coding principles government regulation protocols party requirements regarding billing education current bachelor science psychology liberty university 1971 university blvd lynchburg va 24515 psychologychristian counseling administration advocacy case management community relations counseling mental health services programming certification medical coding may 2017 ashworth college skills as400 balance basic benefits billing brochures calculator call center cms cpt coding cpt credit client clients customer service forms icd9 internet explorer team lead team leader microsoft access excel office outlook powerpoint power point word microsoft word police coding sales phone