Seeking a position where I can continue to acquire new knowledge and contribute interpersonal administrative skill. Fifteen years of work experience in the customer service and administrative filed duties demanding strong organizational, technical, and interpersonal skills. I have excellent oral, written and communication skills, competent researcher and problem-solver. I am committed to performing superior customer service, with the ability to effectively serve diverse populations. I am ethically trustworthy and consistent with follow-through. Excellent rapport with individuals at all levels, displaying a polished, cheerful and welcoming demeanor. I am skilled at multi-tasking, detail-oriented, and successful at completing projects and assignments in a timely manner. Capabilities include: Problem Solving Claims Processing Data Entry, Filing & Data Archiving Switchboard & Front Desk Reception Contract Negotiation Accounts Payable/Receivable Office Equipment Operation Computer Operations Customer Service & Relations
Microsoft Office Suites 07
Customer Service Authorization CoordinatorMay 2014 to Current Glory Healthcare － Loganville, GA
Directly oversee all of insurance authorizations for patients to include initial, recertification and any additional authorizations needed to meet the patient's plan of care.
Review & processed all incoming patient referrals.
Maintain knowledge of the payer's provider contracts and authorization requirements and is able to communicate with the authorization representatives in a professional manner with the documentation needed to secure the authorization needed to meet patient goals.
Obtain authorization of home health services daily and inputting accurate authorization information in our patient management software on a daily basis Accountable for receiving, screening and processing all referral information.
Secure patient demographics, insurance coverage, physician and current health status, including clinical history and physical information, medications, lab work, procedures performed with results and social history.
Audits intake documents for completeness.
Responsible for the effective administration off all daily patient referrals and coordination of intake operations.
Ensure maximum third party reimbursement through direct oversight of insurance verification and authorization process.
Establishes and maintains positive working relationship with current and potential referral sources.
Provide additional information about our services to physicians, customers and third party payer's as needed.
Assist in scheduling evaluation and admission visits.
Maintains record of "non-admit" referrals and reports as required.
Investigate, verify and document coverage from all payer's sources.
Tracks all referrals/admissions.
Receive and relay correspondence, track physician orders and updates.
Communicate appropriate information to team members regarding new admissions and referrals, including client needs such as a plan of care, supplies, and equipment.
Prepare and maintain patient file.
Audits charts to ensure that medical records are complete and accurate.
Maintains office supplies, handouts, and medical-record supplies.
Personnel Employment SpecialistOct 2012 to Apr 2014 Personal Detachment Support Center － Camp Pendleton, CA
Provided enlisted personnel with information and counseling related to Navy occupations.
Maintained and entered data into Enlisted military Service Records.
Processed and preformed all gained personnel to new commands, transferring personnel, preparing personnel for retirement/Fleet Reserve.
Prepared all military separations, retirements, reenlistments and discharges.
Providing (A-L) enlisted military personal with information and counseling related to Navy occupations, opportunities for general education and job training, requirements for promotion, and rights and benefits.
Assisted enlisted (A-L) military personal including their families with special problems or personal hardships advanced pay.
Assigned units and military housing quarters.
Activated and maintained meal pay, childcare, cola, BAH and family care plans.
Perform counseling and interviewing personnel on a variety of matters.
Administered and active advancement examinations.
Order advancement examinations and process examination returns.
Processed and made recommendations for new military assignments.
Wrote official letters and reports for Active duty Navy personal letters (A-L).
Provided pay and entitlement information to individual Navy members.
Maintained and activated military payroll and accounting databases for disbursement and collection of government funds.
Performed travel claim accounting.
Activated military medical benefits such as Tri-care, Met-life Dental, Vision STGLI.
Provided education and counseling on retirement pay, separation pay, VA benefits.
Processed activate duty service members (A-L) medical claims for services.
Prepared financial reports.
Served as agent cashiers to pay government funds.
Acted as collection agents of money owed to U.S.
Treasury by Navy personnel.
Maintained and audited Automated Teller Machines onboard the ships assigned while provided and exhibited professional quality customer services.
Tri-care Member Service RepresentativeJun 2011 to Oct 2012 Tri-West Healthcare Alliance － Camp Pendleton, CA
Primary responsibilities were to provide customer service to all TRICARE beneficiaries in the field, respond to questions, and research information to assist beneficiaries with all TRICARE needs.
Provided assistance to walk-in customers and answered beneficiary-related questions regarding the TRICARE program as well as information and assistance about TRICARE related eligibility, enrollment process, and referrals to network providers.
Accepted enrollment payments, promoted utilization of the Military Treatment Facility, and researched authorization, referrals, and claims information using on-line systems.
Communicated with hospital staff, answered all questions about TRICARE process and procedures as well as individualize, compassionate, and single-visit resolution of customer service encounters for walk -in beneficiaries and hospital staff.
Conducted group presentations to specific military units and supported the consulting tracking function by following up with specific providers on consulting reports.
Processed referral for specialty care and assigned contracted providers with the MPN network.
Ensured that all customer service duties included TRICARE eligibility and benefits, enrollment, referrals and authorizations, access to care, claims, and other assistance.
Performed a variety of consult tracking activities including data input and fully documented and processed all billing daily to assigned beneficiary records in (WRDA) the West Region Desktop Application system, took the appropriate steps to ensure all documentation was completed for each contact using system procedural guidelines.
Assisted as well as helped beneficiaries with understanding the grievance and appeals process when they are dissatisfied with provider care and services.
Knowledgably explained the written grievance and appeals process.
Maintained effective relationships with Military Treatment Facility hospital staff, civilian provider staff, and Hub and corporate staff who supports the TRICARE Service Center.
Assisted the call center with on customer inquires as well as Performed follow up calls on customer issues, research problems and process all necessary paperwork to resolve issue.
Insurance Verification SpecialistJun 2009 to May 2011 Alliance Orthopedics and Physical Therapy － Fredericksburg, VA
Responsibilities were but not limited to verify all major medical insurance including Medicare, Medicaid and Workers Compensation benefits for patient scheduled for surgery.
Research and obtain correct CPT and Diagnostics codes Obtain referrals for schedule surgery and submitted medical and clinical records for precertification required from insurance carriers Processed all required paper work that was received on the patient's behalf and accurately scan the documentation in to the EMR system and file accordantly in a timely manner.
Process all billing electronically and paper claims using CMS (1500) UB-42 for physical therapy and pain management and surgeries.
Contacted all patient within the call center to confirm schedule surgery appointments as well as relay and collect co-pays and co-insurance Post payments from EOB's , process refunds and adjustments, credits maintain collect and aging reports up to 120 days Communication with the surgical center using computer software systems Advantex and Nenterprise for scheduled surgeries as well as contacted patients to confirm and inform of surgery dates as well relay and collect on co-pays.
Order Management SpecialistAug 2008 to Feb 2009 Inuit Inc － Fredericksburg, VA
Provided support and customer service for QuickBooks, Quicken, and Accountant Professional Davison and Turbo Tax/external customers.
Troubleshoot and resolved customer billing inquires using Oracle, Payment-tech and Siebel.
Researched and resolved problematic orders (due to system issues) forwarded from other businesses.
Process exceptions and customer service request from other departments and business units in an appreciate manner.
Contacted customers on undeliverable products return to the warehouse as well update address in CRIS and reship products to customer as well a provided assistant as required.
Contacted and followed up with customers on billing issues as well collected on past due accounts along with setting up payment arrangements using all resources available to collect on payments.
Process credit cards payment for Lacerate as well as update expiration dates on credit card payments in CRIS.
Negotiated concessions with customers using company supported means to reach a mutually satisfactory resolution.
Worked on moderate high complex problems independently using thoughtful judgment within the department as required.
Acted as a point of contact for other departments and business units for resolution of billing issues.
Processed RPT, Complex returns, Charges Backs, ASI automations as well as Open Blanks on a daily basic and as que's are reloaded and assigned.
Supervised managed OOP agents as well as provided training and coach to new employees of the OOP department as well as promoted team work.
Completed all training and meetings as required by the Order Management team Provided customers with product and service information utilizing excellent written and oral communications skills.
Reimbursement AnalystJan 2007 to Aug 2008 Parexel International － Centreville, VA
My responsibilities were to research and verified prescription benefits for patients diagnosed with osteoporosis for the medication Forteo.
Contacted and communicated with all major the insurance carriers included research eligibility via Medicare, and state Medicaid and pharmaceutical companies to obtain benefits on behalf of the doctor's offices and patients and contracted providers.
Communicated with contracted providers and patients and relayed benefits of coverage via telephone fax, scan and email.
Provided customer service inquires on the medication Forteo and assist with application process for Lilly Medicare, Medicaid answers program.
Call Center Service RepresentativeSep 2005 to Dec 2006 Pacific Marine Credit Union － Camp Pendleton, CA
Provided prompt and attentive service to Credit Union members including a variety of financial transactions via telephone.
Opening and closing of accounts.
Answered a high volume of call presented in the que's system Maintained average calls time under 6mintues as a part of call center policies and procedures.
Provided member with product and service information that where offered from the credit union.
Worked on moderate high complex problems independently using thoughtful judgment within the credit union and call center guide line as required.
Processed power of attorneys as assigned as my daily task using teller vision on top of call center dues.
Provided account and loan histories with the use of Loan Pro.
Performed payment transfers and withdraws, processed bank to bank wires, western unions along with check by mail.
Assisted members with re-ordering checks Received payments and post amounts paid to customer accounts.
Communicated with card services department on holding process of credit and debit cards.
In addition communicated with all departments to resolve any related issue on by half of the member and the credit union.
Located and monitored overdue accounts, using computers and a variety of automated systems.
Recorded information about financial status of customers and status of collection efforts.
Provided telephone customer support for the collection department on past due account.
Located and notified customers of delinquent accounts by telephone, and solicited payment.
Conferred with customers by telephone to determine reasons for overdue payments and to review the terms of sales, service, or credit contracts.
Advised customers of necessary actions and strategies for debt repayment.
Persuaded customers to pay amounts due on credit accounts or no payable checks.
Sorted and filed correspondence, and performed miscellaneous clerical duties such as answering correspondence and writing reports.
Demonstrated the ability to maintain composure and work efficiently in a fast pace environment.
Managed customer relations and handled follow up with difficult situations to mutually resolve complicated issues.
Performed various administrative functions for assigned accounts, such as recording address changes and purging the records of deceased customers.
Arranged for debt repayment or established repayment schedules, based on customers' financial situations.
Completed all required and additional training offered by the credit union and any other special training and requirements offered by the call center.
Provided excellent customer service and exhibited a positive, motivated, calm, cheerful, and caring and helpful attitude at all time to callers, co-works staff of the call center and credit union.
Education and Training
Bachelors Degree, Business Management5 2015Business Management
Medical Billing and Coding Certification Career Steps (2009)
Clinical Medical Assistant Certification1 2009Northern Virginia Community College