I am a team player with excellent customer service skills that I apply with sound judgment. I give meticulous attention to detail. I have the ability to resolve problems tactfully and diplomatically.
Proficient at using Excel to create spreadsheets for various tasks
Typing speed 40 wpm
Exceptional interpersonal communication
Excellent time management skills
Effective problem solver
ICD-10 (International Classification of Disease Systems)
Medical terminology expert
Process improvement Effective workflow management
Exceptional telephone etiquette
Records management professional
HCPCS Coding Guidelines
Understands anesthesia coding
Familiar with commercial and private insurance carriers
Research and data analysis
Resourceful and reliable worker
Close attention to detail
Excellent verbal communication
Ambulance coding familiarity
Appeals and Grievance Coordinator, 04/2013 to Current Cambia Health Solutions/Regence FEP – Tacoma, Washington
Analyze and research member and provider reconsideration requests related to adverse claims and benefit determinations according to the Federal Employee Health Benefit Plan's standards while following very stringent timelines.
Determine the best course of action on handling the reconsiderations based upon my research and create final outcome letters upon my findings.
Organize and updated files on each request we receive for legal and business purposes.
Process Advance Benefit Determinations and create letters based on the medical review.
Member eService written response within 24 hours.
Collaborate daily with my team and other departments, such as claims, medical review, and provider relations.
Assumed ownership over team productivity and managed work flow to meet or exceed quality service goals.
Facilitated inter-departmental communication to effectively provide customer support.
Provided accurate, specific and timely performance feedback for CSRs.
Managed work flow to exceed quality service goals.
Member Service Specialist I-II, 02/2012 to 04/2013 Cambia Health Solutions/Regence FEP – Tacoma, Washington
Answering incoming calls from members and providers seeking assistance with benefits and claim information.
Managing personal follow up reports.
Working a "No Name Fax" queue and disseminating the information to the proper area.
Researching and solving complex billing issues for members and providers.
Provided thorough and accurate benefit and claim information.
Deescalating difficult phone calls with members and providers offering compassion, support and solutions.
Promoted from a level one to a level two in less than a year.
Investigated and resolved customer inquiries and complaints in an empathetic manner.
Adhered to all confidentiality requirements at all times.
Met all customer call guidelines including service levels, handle time and productivity.
Solved unresolved customer issues.
Promptly responded to inquiries and requests from members.
Medical Records, Patient Service Representative, 08/2000 to 02/2006 The Doctor's Clinic – Silverdale, WA
Filing and maintaining medical records, execute release of medical records following Washington State Law, greet and direct patients, establish and maintain demographics and insurance information.
Scheduling appointments, collecting/posting payments, balancing and making daily deposits.
Utilize insurance verification websites such as Provider One and One Health Port.
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Adeptly managed a multi-line phone system and pleasantly greeted all patients.
Verified patients' eligibility and claims status with insurance agencies.
Prepared patient charts accurately and neatly for the clinic.
Administrative Assistant, 01/2000 to 01/2006 Discovery Montessori School – Port Orchard, Washington
Liaison between parents and teaching staff, payroll and benefits, business and payroll tax preparation, account and student records, coordinator of volunteers and outside educational activities, coordinator of crisis/disaster response team.
Publishing of monthly newsletter and correspondence with parents.
High School Diploma: 1986 Lindbergh High School -
Cooperative Preschool Program: child developement, 1993 Olympic College -
Certificate: 1998 Washington State Tietle 1/Learning Assistance Program -
Certificate: Electronic Medical Records, 2013 Health IT Certification -
INTEREST & ACTIVITIES -
Spending time with my family boating, camping and hiking, competing in sprint distance triathlons, camping and hiking.