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3rd Party Billing Representative Resume Example

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3RD PARTY BILLING REPRESENTATIVE
Professional Summary
I want to start my career and grow with a company or organization, utilizing my thirteen years of pharmaceutical experience, nine years of management and education to help build and grow from within.
Skills
- Knowledge of medical terminology, HCPCS, and ICDI9's resources.

- Platforms: EMR , Microsoft programs, CATS, R2W Systems, Citrix, CRT, Framework, Pixies Machines, Docutrack, Aux systems, , Kronos.



- Database: Epremises, EDI, Consolidated A/R, A/P Billing Systems (CARS), and CPR Plus.

- Medical Internet Links, Rx 2000 edition.

Work History
04/2015 to Current
3rd Party Billing RepresentativeCompany Name – City, State
  • Document and resolve billing issue from private pay customers.
  • Research, resubmit and process daily rejected claims.
  • Consult with the third party billing managers and pharmacy manager about problems due to pharmacy procedures.
  • Submit prior authorizations and process refills.
  • Follow up with point persons on pending prior authorizations.
  • Maintain and reconcile low income subsides.
  • Obtain one time overrides from insurance companies.


09/2014 to 03/2015
Overnight Data Entry TechnicianCompany Name – City, State
  • Enter 28 orders per hour.
  • Verify billing information, NDC's, J codes, Policy numbers, and sigs.
  • Contact insurance companies for prior authorization.
  • Answer phones, faxes, prescription request.
  • Resolve insurance or third party issues.


05/2013 to 08/2014
Data Entry Specialist SupervisorCompany Name – City, State
  • Develop audit summary and recommendations for review.
  • Follow up with divisions regarding audit findings to ensure corrective measures have been implemented.
  • Review state compliance for days' supply, invalid prescriber, overbilled quantity, missing hard copies of prescriptions, invalid DEA, missing DX codes, fill directions.
  • Develop policies and procedures for new pixies accounts.
  • Manage RX reports, provide in house support, and obtain billing reversals and approvals.
  • Contact physicians and insurance companies to obtain resolutions for PA and script issues.


01/2013 to 05/2013
Triage Assitant ManagerCompany Name – City, State
  • Manage the day-to-day operations of a team of associates in a healthcare call center environment, ensuring that activities run smoothly and efficient.
  • Provides supervision, guidance, coaching, and training to staff.
  • Plan and direct work flow and project assignments; ensures department is appropriately staffed and work load is manageable.
  • Oversee call volume to ensure service standards are met.
  • Collaborate with leadership to develop policies, procedures and the business work plan for the team.
10/2012 to 01/2013
Triage SpecialistCompany Name – City, State
  • Resolve customer complaints, issues and concerns.
  • Research questions, issues, and concerns as directed by management .
  • Answer incoming customer calls prioritize and respond appropriately.
  • Respond to inquiries collect, prioritize and sort incoming faxes to the appropriate department/area.
  • Initiate non-discretionary calls to facilities.
  • Communicate with pharmacy field staff via email, phone or fax regarding patient changes received from facilities.


10/2010 to 04/2011
PSR / Accounts Manager Company Name – City, State
  • Place over 95 outbound calls per day.
  • Take over 80 inbound calls from physicians and payers.
  • Contact physicians and Insurance companies to obtain resolutions for PA issues / script issues.
  • Prepare medications and set up delivery arrangements.

09/2003 to 09/2010
Leah Pharmacy Tech / CPHTCompany Name – City, State
  • Manage 8 CPHT and their productivity.
  • Order and manage all routine drugs for inventory.
  • Enter and verify billing information, NDC's, J codes, Policy numbers, and sigs.
  • Contact insurance companies for authorization.
  • Answer phones, faxes, and prescription request, and insurance or third party issues.

Education
Current
GED:
PENN FOSTER UNIVERSITY - City

2003
GED: Managment
HACKENSACK HIGH SCHOOL - City
Certifications
  • Pharmacy Technician Certificate
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Resume Overview

School Attended

  • PENN FOSTER UNIVERSITY
  • HACKENSACK HIGH SCHOOL

Job Titles Held:

  • 3rd Party Billing Representative
  • Overnight Data Entry Technician
  • Data Entry Specialist Supervisor
  • Triage Assitant Manager
  • Triage Specialist
  • PSR / Accounts Manager
  • Leah Pharmacy Tech / CPHT

Degrees

  • GED :
    GED : Managment

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