Customer Service Advocate Resume Example CGS Administrators

CUSTOMER SERVICE ADVOCATE

Summary

Detail-oriented Administrative/ Clerical support with extensive experience performing medical clerical duties and supporting 5 physicians in a busy medical office. Expertise includes with excellent communication skills demonstrated by18 years of experience, verifying insurance coverage, records reviews and schedule maintenance.

Highlights

Results-oriented
Maintains strict confidentiality
Meticulous attention to detail

Excellent communication skills
Team player with positive attitude
Strong work ethics

Experience

Customer Service Advocate
May 2014 to CurrentCGS Administrators － Nashville, Tennessee

Provided accurate and appropriate information in response to customer inquiries by Medicare Part B providers
Explain Medicare Part B claim denials and how to correct claim for payment.
Provide reference and resource material to providers and conduct research into some denials
Verify and confirm beneficiary eligibility in Medicare Part A and B.
Strictly followed all federal and state guidelines for release of information.
Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.

Customer Service Representative
September 2013 to May 2014CVS Caremark － Nashville, Tennessee

Addressed customer service inquiries in a timely and accurate fashion.
Explaining current Medicare D drug plan to members
Taking medication refill orders
Researching plan design copay structures and formulary change
Providing pleasant, accurate customer service
Providing information regarding changes to Medicare Part D drug plan structures Providing Medicare mandates procedures and updates.

Surgery Scheduler
March 1999 to June 2013Vanderbilt Medical Center － Nashville, Tennessee

Efficiently performed insurance verification and pre-certification and pre-authorization functions.
Sending redetermination to insurance both private and government for surgical procedures
Coordinate surgery schedule with patient, physician and operating room and provide patients with detailed information regarding dates, time scheduled and necessary
Arrange and schedule pre-operative test for patient and maintains operating room schedule instructions, as directed by physicians.
Contact patient to remind of post-operative instructions, as directed by physicians.
Working knowing in Star Panel, Epic Hyperspace, and other systems
Verify patient eligibility, coverage for procedure,obtain pre-certifications, authorizations for procedures and tests ordered by physician.
Notify and forward paperwork for insurance certification to Billing Office and obtain additional paperwork if needed for compliance.
Responds to written and telephone inquiries from carriers regarding surgeries
Perform clerical duties to support physicians and the surgery scheduling function regarding patient and surgery information

Office Assistant III
February 1996 to March 1999Vanderbilt Medical Center － Nashville, Tennessee

Responsible for printing daily schedules to pull medical records for clinic appointments and surgeries.
Recorded and filed patient data and medical records
Scanned and indexed clinic notes, pathology reports, lab tests, financial information in Electronic health record system
Performed various administrative duties, including data entry and document preparation.
Eliminated outdated records on annual basis by sending the records to be scanned
Assisting medical students, doctors, nurses and secretaries archival retrieval
Pick up, sort and distribute mail for clinic.

Clerk III
January 1995 to February 1996Vanderbilt Temporary Service － Nashville, Tennessee

Developed and created a more effective filing system to accelerate paperwork processing.
Printing daily schedules, pull medical records for clinic.
Verified that information in the computer system was up-to-date and accurate for appointments and surgery.
Dispersed incoming mail to correct recipients throughout the office.

Education

Bachelor of Science : Health Care Administration with Concentration in Management, 1991University of Phoenix － Nashville, Tennessee

Health Care Administration ,still in progress will graduate June 2016

High School Diploma : Psychology , 1990Belmont University － Nashville, Tennessee

Studies included Statistical Mathematics, Western Civilizations , Majoring in Psychology Minor in Sociology

Algebra I & IIStratford High School － Nashville, Tennessee

Studies included Algebra I &II and Trigonometry, Geometry and French I &II H

Accomplishments

Healthcare Administration- still in progress Accomplishments Certificate thru Vanderbilt Training and Development Organizational Skills Certificate received on June 22, 2000.
Attendance in Tenn-care in-service May 2003, January 2004, March 2004, July 2005, August 2005 for BCBS pre-certs.
Working knowledge in Excel and with CPT coding, Completion of Administrative Assistants Conference September 2008.

Skills

Scheduling, Strong verbal skills, Excellent written skills, ICD-9 and CPT coding

Resume Overview

Companies Worked For:

CGS Administrators
CVS Caremark
Vanderbilt Medical Center
Vanderbilt Temporary Service

School Attended

University of Phoenix
Belmont University
Stratford High School

Job Titles Held:

Customer Service Advocate
Customer Service Representative
Surgery Scheduler
Office Assistant III
Clerk III

Degrees

Bachelor of Science : Health Care Administration with Concentration in Management , 1991
High School Diploma : Psychology , 1990
Algebra I & II

Customer Service Advocate Resume Example

Resume Score: 90%

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