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JC
Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Professional Summary

Medical Records Clerk/Records Clerk with over 26 years of successful experience in scheduling appointments, coordination with multiple appointments, Insurance Eligibility Verification, deposits, and payments. Recognized consistently for performance excellence and contributions to success in the legal and medical industry. Strengths in high attention to details, and time management backed by training in Medical Billing.

Accomplishments
  • Saving the county large amounts of funds by implementing cost-saving initiatives that addressed long standing problems, after approval from the County Attorney and Judge for reimbursement court costs.
Skills
  • Insurance Verification
  • Professional Customer Service
  • Medical Terminology Certification
  • Communication Skills
  • Time-Management
  • High attention to details
  • Decision Making
  • Microsoft word and Microsoft Outlook
  • Multitasking abilities
Skills
  • Medical records documentation
  • :
  • Insurance verifying
  • :
    Intermediate
  • Medical insurance knowledge
  • :
  • Payment collection
  • :
    Expert
  • Ability to follow up with 3rd party payors for claims and appeals
  • :
  • Patient demographics & Patient care and confidentiality
  • :
  • Skill in interpreting UB04/CMS claim data
  • :
  • Ability to audit accounts and payor Explanation of Benefits
  • :
  • Documentation review
  • :
  • Organization and time management
  • :
  • Communication Skills
  • :
  • Knowledge and understanding of Health Insurance
  • :
  • Self-Motivated
  • :
  • Resolving Issues
  • :
  • Customer Service
  • :
  • Problem Solving
  • :
  • Self-Management
  • :
  • Phone Calls
  • :
  • Account Management
  • :
  • Decision Making
  • :
  • High Attention to Details
  • :
  • Customer Relationship Management
  • :
    Work History
    10/2018 to 04/2019 Customer Service Associate Masterbrand Cabinets Inc. | Fairdale, KY,
    • Politely assisting customers and responding resourcefully to requests and request concerns.
    • Issuing credit(s) and refunds after approval by management. Placing items in correct area for reporting on defective or damage items resulting from shipping process.
    • Processing and managing over 100 purchases per day and handling transactions through POS system.
    • Increasing customer service by decreasing waiting times.
    • Stocking, rotating, and removing items near expiration date from all locations to ensure items are used within recommended time frames.
    • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
    • Maintained clean personal appearance of store when by stocking shelves, organization and arrangement of merchandise.
    09/2020 to Current Insurance Validation Marmon Holdings, Inc | Cleveland, TX,
    • Training in COB and Insurance Eligibility, which includes: primacy rules for priority payment, integration of benefits, Medicare training, secondary insurance, end stage renal disease.
    • Established & understanding of reason codes: dependent not covered, payment prior to coverage, terminated coverage, lapse of coverage.
    • Established & understanding of Medical terminology: Medical Terminology Certification.
    • Established understanding of terms, example: advanced beneficiary notice, prior authorization, timely filing, non participation provider, participating provider, remittance advice.
    • Documentation of each account for accuracy in reference to details of eligibility.
    • Being in compliance with HIPAA on all accounts.
    • Documented entire validation process, noting changes or alterations completed.

    Third Party Liability Claims Researcher:

    March 2020 to September 2020

    • Contacting attorney's offices, representatives of insurance carriers, insurance carrier adjusters, and workmen's compensation carriers for medical claims to determine if there is potential case for third party liability.
    • Established and updating all account information to ensure that all information is accurate for future referencing.
    • Performance compliance with HIPAA on all accounts..
    • Performing documentation of each account for accuracy in reference to details for managing account and medical expenses.
    • Establishing and obtaining information from attorney's offices, insurance adjusters, and workmen's compensation by letters for determination of interests on when necessary.
    • Managing over 35 calls per day.
    • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines
    01/2019 to 12/2019 Customer Service Representative Southwest Business Corporation | Dallas, TX,
    • Adhered to company policies and scripts to consistently achieve call-time and quality standards.
    • Resolved customer complaints and addressed emergency requests and needs.
    • Monitored fax cues and send confirmations for prescriptions.
    • Updating and adding patient profiles
    • Adding and verifying insurance information.
    • Collecting documentation for billing.
    • Received inbound/outbound calls from members and pharmacy staff.
    • Track refills of prescriptions and coordination of delivery to ensure timely processing without delays for patient.
    • Processing western union payments, credit cards, and debit card transactions.
    • Arranging debt payment or establishing repayment plans based on customers financial situation.
    • Resolving account issues that need to be addressed.
    2014 to 2019 Coordinator City Of Auburn | Auburn, WA,
    • Managed and maintained multiple 6 schedules per week, travel arrangements, and other administrative support tasks for client.
    • Direct communication with nurse and hospital staff members about prior authorizations, documents, and release of medical information according to HIPAA.
    • Assist elderly with appointments to and from their home.
    • Assisted elderly with meals, grocery shopping, daily needs in home.
    • Assisted elderly with applications for housing in community.
    • Received instructions on durable medical equipment (Oxygen Concentrator/tank/cords/ masking and pick up prescriptions from pharmacy).
    • Made over 10 calls per week: checking in on client, doctors appointments for bi-weekly appointments (items that were needed or change in RX, change in RX instructions.
    06/1991 to 09/2017 Records Clerk Dodge County Court | City, STATE,
    • Developed and initiated monthly payment plans for customers on outstanding accounts, both small and large accounts.
    • Communicating with customers about their account(s) and collecting outstanding balances.
    • Researched and resolving any questions or concerns on account balances for customers immediately.
    • Posting payments, providing change back when necessary and issuing receipts.
    • Clerical duties and tasks, including: scheduling multiple appointments, and calenders, arranging conference calls and placing conference calls, re-directing phone calls, filing, batching mail, weekly postage outgoing mail for office, taking messages for appropriate staff members, and greet visitors.
    • Maintaining attorney database accounts weekly by keeping accounts in good standing. Bi-weekly attorney billing.
    • Juvenile guardianships, emergency contacts, and custody orders.
    • Cashiered, balancing daily cash drawer, and cash handling.
    • Receiving and routing medical records to appropriate files for scanning.
    • Maintained current and accurate medical records for over 300 juvenile court cases per year. Updated records with new information.
    • Creating and preparing legal drafts by organizing and assembling information for legal documents and forms.
    • Professional customer service in friendly, efficient manner ,
    • Scanned paper documents into computer and assigned identification numbers to simplify tracking process updating records with new information.
    • Sorted all paperwork and documents alphabetically and according to dates and significance.
    • Assisting with typing, data entry and answering incoming calls as required.
    • Assisting and working with counsel, Guardian Ad Litem, court orders for release medical records, place children in out of home placements, hospitals, detention centers, inpatient and out-patient treatment facilities.
    Education
    Expected in 08/2021 Certification | Medical Billing Specialist American Academy of Professional Coders, Cincinnati, OH, GPA:
    • ANTICIPATION COMPLETION OF CERTIFICAITON of Medical Billing Specialist expectation of August , 2021.
    • Medical terminology certification.
    • Continuing course work in Medical Billing Training.
    • ICD-10 Book Course
    • On-line Course work
    Expected in 05/1989 Bachelor of Science | Business Administration And Management Midland Lutheran College, Fremont, NE, GPA:
    Certifications
    • Medical Terminology Certification December 3, 2019

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    School Attended

    • American Academy of Professional Coders
    • Midland Lutheran College

    Job Titles Held:

    • Customer Service Associate
    • Insurance Validation
    • Customer Service Representative
    • Coordinator
    • Records Clerk

    Degrees

    • Certification
    • Bachelor of Science

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