, , 100 Montgomery St. 10th Floor(555) 432-1000, resumesample@example.com
Summary
Jessica Claire Objectives Position utilizing my current; customer service, computer, and leadership experience to effectively enhance and add value to company operations. To succeed in an environment of growth and excellence and earn a job which provides me job satisfaction and self-development to help me achieve personal as well as organization goals. Seek challenging assignments and responsibility with an opportunity for growth and career advancement as a successfully achievement. Profile Nine years of continuous and progressive experience in; counseling, protective and rehabilitative services, customer service, and interpersonal skills.
Goal-oriented individual with strong leadership skills and abilities.
Organized, highly motivated, business oriented, detail-directed, and problem solver.
Flexible, lifetime learner, with excellent customer service and computer background.
Skills
Microsoft Office Suite software programs; Word, Excel, PowerPoint, Outlook
Knowledge of Medicare, Medicaid and commercial plans
Adaptable, Dependable, Determined and Responsible
Excellent verbal communication skills (vocabulary and articulation)
Ability to express assurance/confidence and empathy
Customer service experience
Detail-oriented
Documentation & Reporting
Leadership skills
Accounts payable and receivable
Interest calculations
Proficiency with CPR+
Invoice processing
Claims processing
Medical billing and collections
Coding proficiency
Experience
05/2019 to CurrentBilling CoordinatorBhdp Architecture | All Locations, OH,
Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
Kept up-to-date with details of insurance plans and company requirements.
Liaised with patients, insurance companies and billing office personnel to effectively create and post bills, obtain payments and update system information.
Calculated figures such as discounts, percentage allocations and credits.
Verified proper coding on more than claims per week, investigating and resolving issues to maintain billing accuracy.
Performed insurance verification, pre-certification and pre-authorization.
Checked claims coding for accuracy with ICD-10 standards.
Submitted claims to insurance companies.
Participated in educational opportunities, including workshops, seminars and training classes to gain stronger education in industry updates and federal regulations.
Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
11/2013 to CurrentOwner and CEOCarepathrx | Dallas, TX,
Planned and directed all functions of the company – Enforced strong leadership skills to ensure efficient/effective utilization of corporate resources.
Established and integrated the functional strategies of the company utilizing business expertise to reach financial/operational goals and objectives.
Deployed resources to achieve financial forecast and business objectives.
Record of success in guiding and directing an ABC enterprise through substantial change management, balancing engagement with strong and effective strategic leadership.
Developed sales and marketing plans and programs for company sales personnel.
Analyzed market trends and statistics to determine potential of growth – monitored sales performance regularly.
01/2019 to 05/2019Intake CoordinatorOne80 Intermediaries | Westbrook, CT,
Utilize CPR+ to check eligibility, run test claims/reverse online claims as required.
Initiating and following up on Prior Authorizations.
Knowing and understanding how to properly calculate total drug cost based on the contracted rate between insurance and provider.
Point of contact between pharmacy, provider, and sales reps.
Organizing and managing daily morning meetings.
Initiating appeals and collecting appeal information as well as LMN’s to forward to insurance plan.
Knowledge of Commercial and Government plans.
Other duties assigned.
Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services.
Prepared and sent financial statements to support bookkeeping functions.
Updated group medical records and technical library to support smooth office operations.
Answered phone calls to provide assistance, information and medical personnel access to maximize office efficiency.
Supported administrative and healthcare staff, providing order fulfillment and inventory management services to ease operations.
Managed average of 15 patients per day and processed new claims utilizing appropriate adjudication system.
Investigated insurance policies to determine claim eligibility and processed files in accordance with instructions.
Automated office operations for managing client correspondence, payment scheduling, record tracking and data communications.
Distributed company correspondence, including memos and updates to reinforce and apprise departments and divisions of corporate objectives and developments.
11/2015 to 08/2018Case ManagerMckesson/RxCrossroads | City, STATE,
Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing.
Ability to work in a fast-paced environment, handling both inbound and outbound calls.
Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines.
Good communication skills are essential, both internal and external.
Knowledge of Medicare benefits, enrollments and LIS assistance.
Plans and organizes work assignments, set priorities and completes work with a minimum of supervision.
Adheres to the service policy and principles of the company, as well as the program guidelines set by the department.
Participates in cross-training to perform all roles within the department.
Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners.
Other duties as assigned.
Process/reverse online claims as required.
Assign work equally throughout team.
Provide floor support, assist with supervisor/escalated calls.
Direct contact for client when management is out.
Train new case managers on job duties/responsibilities.
Responsible of submission of authorization forms to insurance plans.
Education and Training
Expected in 06/2008High School Diploma | Jefferson County High School, Monticello, FL, GPA:
Expected in | Florida Agricultural And Mechanical University, Tallahassee, FLGPA:
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