Customer Service Advocate Resume Example
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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
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Experience
Customer Service Advocate
May 2014 to CurrentCvs Health － Phoenix , AZ
May 2014 to CurrentCvs Health － Phoenix , AZ
- 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 2014Metals Usa － Langhorne , PA
September 2013 to May 2014Metals Usa － Langhorne , PA
- 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 2013Oregon Medical Group － Eugene , OR
March 1999 to June 2013Oregon Medical Group － Eugene , OR
- 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 1999Alamance County － Alamance County , NC
February 1996 to March 1999Alamance County － Alamance County , NC
- 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 variousadministrative 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 1996City Of Chattanooga － Chattanooga , TN
January 1995 to February 1996City Of Chattanooga － Chattanooga , TN
- 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 － City, State
Health Care Administration ,still in progress will graduate June 2016
High School Diploma : Psychology , 1990Belmont University － City, State
Studies included Statistical Mathematics, Western Civilizations , Majoring in Psychology Minor in Sociology
Algebra I & IIStratford High School － City, State
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
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Resume Overview
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
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