Customer Service Rep, Medical Biller or Coder, Social Services, Retail, Medical Receptionist, Administrative Assistant
Skills: Customer Service, clerical duties, filing, receptionist, medical biller and coder, data entry, ICD 9 HCPCS, CPT Codes, case management, social services.
Medical Billing & Coding
ICD 9/ICD 10
Investigated any necessary information for proper billing for insurance companies, patients and DMEs such as proper billing codes.
Greeted customers upon entrance and handled all cash and credit transactions.
Assisted customers over the phone regarding store operations, product, promotions and orders.
Researched, calmed and rapidly resolved client conflicts to prevent loss of key accounts.
Customer Service Representative10/2014 to 12/2016Capital Blue Cross Harrisburg PaHarrisburg, PAContacted insurance providers to verify correct insurance information and get authorization for proper billing codes.
Updated patient accounts and information on a daily basis.
Communicated with patients via phone, email and in person to obtain payments on outstanding accounts or accounts requiring deductibles or co-pays. Receive inbound calls from members, providers, brokers and insurance agents in regards to coverage, benefits, prior authorizations, referrals, billing, sales, reinstatement's, medications, appeals, grievances and complaints and technical issues online.
Departments worked in are Senior Blue, and Individual Accounts.
Members that have coverage through CBC directly or the Federal Facilitated Marketplace.
Software and systems used are faucets, Rad MD to research prior authorizations and denials for medical services.
Check Recon to verify payments sent or receive by providers and Members.
Clarity which is utilized to track and view ID cards submitted.
Work Desk to review other documents.
Process payments for premiums.
CVS Caremark to verify prescriptions, co pays, denials, and rejections.
Review Coordination of benefits.
Clear Tran to verify payments and refunds received.
Verify explanations of benefits and review claim information submitted by providers.
I am familiar with plans such as Senior Blue HMO, PPO, Avalon, Medicare Supplement plans, On and Off Marketplace exchange policies, Capital Blue Cross also works with Centers for Medicare and Medicaid, Federal Facilitated Market Place, Keystone Health Plan Central, and the department of Human Services.
Customer Service Rep11/2011 to 04/2013ACS/PennDotHarrisburg, PA
Received inbound calls for Penndot and their services.
Maintains database with accurate information.
Handled calls for registration, license renewals, complaints and suspensions.
Assisted with customers needing information from Penndot.
Direct Support Specialist11/2011 to 02/2012Community Services GroupHarrisburg, PA
Responsible for assisting individuals with MH/MR to live a self-directed life, and daily living activities.
Ensures residents health, safety and welfare in a residential setting.
Assists individuals in the development of appropriate behavioral, social, money management, housekeeping, hygiene, and other skills necessary.
Administers medication and other treatments.
Updates all daily, weekly and monthly records, reports, logs, casework notes and medical records.
Transport residents in personal or company vehicle for community outings or scheduled appointments.
Supervises and completes all duties and responsibilities in the daily operation of the residence in the 24-hour daily operation of the home.
Data Entry/Customer Service Rep12/2010 to 11/2014Express Scripts PharmacyHarrisburg, PA
Data Entry and Research and Correspondence Processed and refill all prescriptions.
Open orders as needed, verify eligibility, input prescriptions while maintaining productivity and quality data entry standards.
Document correspondence and follow up in system.
Prepare audit sheets and provide feedback to supervisors, leads, and management.
Assisted with research of lost or missing orders per internal department requests.
Provide backup support to other pharmacy groups based on business needs or production levels.
Made outbound calls to patients regarding address verification, co pays, health insurance coverage, handling complaints or disputes and shipping methods.
Evening Coordinator05/2007 to 11/2011Shalom House ShelterHarrisburg, PA
Supervision of the shelter, its operation, residents and all activities to support residents to meet their needs for sheltering and safety.
Organize donations, office, house living areas, organized and prepared files, stocked supplies as needed for office.
Coordinated with other staff members to provide case management meetings, attend trainings.
Provide homeless women and children shelter, meals, drug and alcohol treatment, employment, and education in support of their effort to establish an independent, self-sufficient life.
High School Diploma: Medical Billing and Coding2011Kaplan Career InstituteHarriaburg, Pa, USAMedical Billing and Coding
Business Management2018HACCHarrisburg, PA, USABusiness Management
medical billing and coding, case management,Data Entry, customer service, MEDISOFT software, 10 Key, Coordination, Email,Filing, Microsoft Excel, Microsoft Word, PowerPoint, Windows 10