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billing operation specialist resume example with 16 years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Summary

Seasoned Healthcare Insurance Specialist with excellent planning and problem solving abilities. Offering 15 years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.

Skills
  • Highly motivated Certified Support Professional. Diverse background includes medical, customer service, and insurance. Abilities at multitasking to achieve individual and team goal. Committed to quality and excellence.
  • Experience in Leadership
  • Improvement Plan Knowledge
  • Content Management Expertise
  • Relationship Building
  • Planning & Organizing
  • Team Building
  • Problem Resolution
  • Computer Skills
  • Microsoft Office
  • Data Management
  • Organizational Skills
  • Critical Thinking
  • Customer Service
Experience
06/2022 to 09/2022 Billing Operation Specialist Adp | Asheville, NC,
  • Collaborate with internal team and external client to research and resolve any disputes or discrepancies in billed amounts and/or payment transactions
  • Creating invoices and billing material to be directly sent to members
  • Displayed strong telephone etiquette, effectively handling difficult calls.
  • Identified needs of customers promptly and efficiently.
  • Assessed company operations for compliance with safety standards.
  • Organized billing and invoice data, prepared accounts receivable and generated revenue reports to support audits.
  • Identified system and account issues to quickly and accurately resolve.
  • Created reports and audited charts to maintain concise records.
  • Reconciled data to identify anomalies.
  • Supported database performance by evaluating and resolving processing problems and designing database management tools.
  • Responded to daily inquiries and requests within mandated timeframe to meet deadlines.
  • Referred unresolved customer grievances to designated departments for further investigation.
  • Investigated and resolved issues to maintain billing accuracy.
  • Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.
  • Answered customer invoice questions and resolved issues discovered during invoicing and collection process.
  • Input client information into spreadsheets and company database to provide leaders with quick access to essential client data
  • Identified areas for improvement, narrowing focus for decision-makers in making necessary changes.
06/2020 to 05/2022 Provider Data Management Analyst Anderson Hospital | Collinsville, IL,
  • Update provider and practitioners with claims payment and directory information
  • Perform research and resolve problems as necessary
  • Gathered and organized data to analyze current industry trends.
  • Identified needs of customers promptly and efficiently.
  • Worked with internal teams to understand business needs and changing strategies.
  • Audited internal data and processes to identify and manage initiatives, improving business performance.
  • Assisted integration of internal and external data tools and products, maintaining stability and performance across systems.
  • Identified and corrected data entry errors to prevent duplication across systems.
  • Compiled data from source documents prior to data entry.
  • Identified errors in data entry and related issues by mentioning to supervisors for resolution.
  • Identified, corrected and reported data entry errors.
  • Proofread and edited documents to correct errors.
  • Identified system and account issues to quickly and accurately resolve.
  • Exceeded quality goals to support team productivity.
  • Reviewed and updated account information in company computer system.
  • Responded to daily inquiries and requests within mandated timeframe to meet deadlines.
  • Reviewed database entries to verify regulatory compliance.
  • Processed confidential tax form information with care and precision.
  • Compiled, sorted and verified electronic data against hard copies to support quality control efforts.
  • Examined claims, records and procedures to grant approval of coverage.
  • Inputted data into the system, maintaining accuracy of provider coding information and reported services.
  • Accurately processed large volume of medical claims every shift.
  • Organized information by using spreadsheets, databases or word processing applications.
  • Collaborated with fellow team members to manage large volume of claims.
12/2015 to 06/2020 Configuration Specialist Neighborhood Healthcare | Escondido, CA,
  • Performs accurate and timely provider research, verification, and analysis
  • Resolves provider load issues within established documented processes
  • Inputted new claims into computer system which ensured that auditing standards were met
  • Loading, approving/rejecting medical claims
  • Responsible for building and maintaining positive business relationship with business partners.
  • Trained staff and users to work with computer systems and programs.
  • Reviewed and analyzed computer printouts and performance indicators to locate code problems and correct errors.
  • Assisted staff and users with computer malfunctions and program problems.
  • Used computer in analysis and solution of business problems.
  • Supported database performance by evaluating and resolving processing problems and designing database management tools.
  • Corrected data errors and entered missing information into new data parcels being processed for clients, maintaining compliance with guidelines.
  • Identified system and account issues to quickly and accurately resolve.
  • Processed confidential tax form information with care and precision.
  • Audited data regularly to guarantee data integrity and quality.
  • Responded to daily inquiries and requests within mandated timeframe to meet deadlines.
  • Reviewed and updated account information in company computer system.
  • Troubleshot program and system malfunctions to restore normal functioning.
  • Explored new technologies and tools for productivity, security and quality assurance purposes.
04/2014 to 12/2015 Care Coordinator Giant Eagle | Leetsdale, PA,
  • Responsible for providing administration and department support for clinical care management, and field service coordinator staff
  • Utilization Management
  • Facilitated Care coordinator throughout daily operations ensuring sound decisions established relationships, and researched and resolved inquiries to ensure completeness and accuracy
  • Produced and interpreted reports for missing or expired authorizations, non- members with authorization and multiple authorizations
  • Actively listened and provided strong customer service to all clients
04/2011 to 04/2014 Member Engagement Specialist WellCare Health Plans Inc. | City, STATE,
  • Set up and executed customer and partnership contracts to facilitate business objectives.
  • Helped members resolve account problems and navigate internal systems to handle routine needs.
  • Enhanced productivity and customer service levels by anticipating needs and delivering outstanding support.
  • Consulted with customers regarding needs and addressed concerns.
  • Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
  • Discussed ideas and strategies to improve operational efficiency, adding value and aiding business performance for continuous improvement.
08/2006 to 04/2011 Intake Coordinator WellCare Health Plans Inc. | City, STATE,
  • Responsible for handling inbound calls for various referral sources
  • Requested authorizations for continuing care such as verifying insurance eligibility
  • Effectively engage over the phone via both inbound and outbound hospital, provider offices and members regarding authorization for inpatient admissions, ambulatory services, outpatient services, consultation, and treatment services
  • Work as a team member to assist nurses in researching provider,
  • Provide high quality, focused serving using knowledge of plan, systems, and procedures to meet or exceed member and provider experience
  • Entered CPT procedure codes and ICD-9 codes, treating physician and facility from providers request for authorization.
  • Assist with managers urgent request to dealt with in timely manner
  • Received inbound calls to obtain clinical information from providers to create authorizations and referrals.
  • Corresponded with hospitals and medical offices regarding incoming home health referrals.
Education and Training
Expected in to to | Hillsborough Community College, Tampa, FL GPA:

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Resume Overview

School Attended

  • Hillsborough Community College

Job Titles Held:

  • Billing Operation Specialist
  • Provider Data Management Analyst
  • Configuration Specialist
  • Care Coordinator
  • Member Engagement Specialist
  • Intake Coordinator

Degrees

  • Some College (No Degree)

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