Customer Service Representative Resume Example KEPRO, Review Services

CUSTOMER SERVICE REPRESENTATIVE

Experience

Customer Service Representative
July 2014 to April 2015KEPRO, Review Services － Seven Hills, OH

•Identified how to best assist beneficiary callers with our appeal services

•Maintained effective working relationships with both external and internal customers

•Utilized internal quality control tools to assess individual work and team processes

•Lead trainer for all new hires

Quality of Care Representative
April 2015 to CurrentKEPRO, Review Services － Seven Hills, OH

•Triaged all Quality of Care calls to determine the best resolution

•Gave referrals for external agencies outside of our quality of care scope

•Completed all immediate advocacy complaints within CMS guidelines

•Provided status updates to both Medicare Providers and beneficiaries

•Prepared all quality of care complaint and consent forms for review

Product Client Service Representative
August 2011 to October 2012PNC Bank － Seven Hills, OH

•Conducted second tier business-specific customer support to IOCR Advantage Clients

•Answered client inquiries regarding incorrect claim and billing processing

•Gathered detailed root cause analysis from operator processing errors

•Interacted with service partners from the Health Care Imaging team to ensure accurate and timely client feedback and resolution

•Trained all employees on newly implemented processing procedures

Reconciliation/Enrollment Specialist
November 2010 to March 2011Caremark － Solon, OHTemp Position Reviewed current and new members Medicare and Medicaid enrollment information for completeness. Evaluated various systems affiliated with members information to ensure accuracy of insurance plans per departmental guidelines. Modified errors per management and system upload required in order for accurate processing. Trained incoming temps on all systems per management. Also assisted Team Lead as well as Department Manager on various projects. Nolan 2 nolan.ebonie@yahoo.com

Clerical Assistant
February 2007 to September 2009Positive Education Program － Cleveland, OHProvided a complete range of clerical support services for 30+ employees. Entered Care Manager notes for tracking of client billing in companies PEP (Positive Education Program) Client Information System. Retrieved files for auditors of The Board of Mental Health by supplying information to assist in resolving insurance and billing issues. Gathered clients demographics and other related paperwork for various agencies such as Social Security Disability, Rehabilitation clinics, Courts and Lawyers per approved request.

Credentialing Support Specialist
January 2007 to February 2007Area Temps/Franklin & Seidelmann － Mayfield Heights, OHTemp Position Assisted both the Credentialing Manager and physicians by ensuring that all Medicaid and state licensing information was current in company's SyMed system. Updated and processed physicians information in a timely and accurate manner to insure state licensing and provider enrollment. Submitted Medicaid applications, correspondence, and other related materials to physicians for completeness and signatures via fed-ex.

Medical Records Representative
February 2006 to April 2006MetroHealth Medical Center － Cleveland, OHPrepared and processed medical and shot records for patients and outside agencies such as Lawyers, Social Security Disability, and other medical facilities. Generated payment invoices for all outgoing medical records as well as tracked all records received into and sent out of the department in company's EPIC (Electronic Patient Information patient tracking system. Performed a variety of clerical duties including record maintenance, faxing, scanning, photocopying, and front desk support for physicians and nurses.

Medical Records Technician
July 2005 to October 2005Menorah Park Center for Senior Living － Beachwood, OHManaged daily patient census information of all incoming and outgoing patients and updated their charts accordingly. Assisted in collecting patient demographics and insurance information for all new and returning residents as well as assigning medical record numbers. Ensured that residents ADLs (Activities of Daily Living) and care plans from MDS (Minimum Data Sheet) form were correctly entered and updated weekly into companies MDS system. Prepared inactive patient charts for storage and/or auditing purposes.

Data Entry Operator
March 2002 to July 2005Medical Mutual of Ohio － Cleveland, OHReviewed medical claims for accuracy as well as corrected errors, and entering missing data. Maintained control of claims processed by properly following batch control procedures. Performed daily production, procedural, and quality quota of 97% for all processed claims. Informed team leader of unusual situations affecting productivity and efficiency of data flow. Worked with team members meeting and exceeding production deadlines. Assisted in other duties as assigned.

Education

Associate of Science : Healthcare AdministrationCuyahoga Community CollegeCuyahoga Community College Indiana Wesleyan University Associate of Science Bachelor of Science Major: Healthcare Administration Expected: Fall 2015 Expected: Fall 2016

Skills

Billing, Clients, Customer Service, Receptionist, Retail Sales, Claims, Data Entry, Entry Operator, Medical Claims, Quota, Clerical, Disability, Security, Clerical Support, Mental Health, Answering, Benefits, Customer Support, Eobs, Hci, Human Computer Interaction, Liaison, Operations, Optical, Production Environment, Production Schedule, Quality Assurance, Root Cause Analysis, Associate, Healthcare, Customer Service Representative, Quality Control, Imaging, Staffing, Medicaid, Medical Records, Medicare, Reconciliation, Team Lead, Auditing, Epic, Faxing, Front Desk, Invoices, Maintenance, Medical Facilities, Scanning, Correspondence

Resume Overview

Companies Worked For:

KEPRO, Review Services
PNC Bank
Caremark
Positive Education Program
Area Temps/Franklin & Seidelmann
MetroHealth Medical Center
Menorah Park Center for Senior Living
Medical Mutual of Ohio

School Attended

Cuyahoga Community College

Job Titles Held:

Customer Service Representative
Quality of Care Representative
Product Client Service Representative
Reconciliation/Enrollment Specialist
Clerical Assistant
Credentialing Support Specialist
Medical Records Representative
Medical Records Technician
Data Entry Operator

Degrees

Associate of Science : Healthcare Administration

Customer Service Representative Resume Example

Resume Score: 90%

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