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 RepresentativeCone Health – Kernersville , NC
- 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 TechnicianOmnicare Pharmacy – 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 SupervisorPruittHealth Pharmacy Services – 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 ManagerPruittHealth Pharmacy Services – 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 SpecialistPruitt Health Pharmacy Services – 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 CVS Specialty Pharmacy – 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 / CPHTC.V.S Retail Pharmacy – 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
PENN FOSTER UNIVERSITY - City
2003
GED: Managment
HACKENSACK HIGH SCHOOL - City
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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