Livecareer-Resume
Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Professional Summary
To secure a challenging position within Sound path Health, where my Reverence, Integrity and compassion can be displayed as well as my executive presence, customer service, computer skills, my problem solving, proven organizational ability and spirit of Excellence can or will? effectively be utilized to improve operations, and contribute to overall productivity and success, while allowing me the opportunity for advancement and longevity.
Licenses
Skill Highlights
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Professional Experience
Patient Account Representative, 06/2010 to 04/2014
HealthpartnersWoodbury, MN,
  • Research and find root cause for claims insurance companies deny, pay short or do not pay at all A buddy for old and new teammates, submit adjustments, submit Dse tickets A member of an Innovative Team who helps find innovative ways to improve current processes or think of ways to implement new processes Heavily involved in a weekly and monthly close process for several facilities which include but not limited to fixing errors, reviewing multiple reports, submitting tickets and communicating with the facility staff members Work several reports which include SOX report, Drap/RCU report, Weekly flash report, NPSP, BER report, CIER report, MRR report, Snappy reports Maintain a healthy working relationship with both the payers and other teammates, very knowledgeable of multiple insurance companies and their policies and procedures Contact payers to verify benefits, eligibility, claim status and other issues Detect and report trends, research and problem solve.
  • Ability to switch from one task or type of work to another as the business needs require.
  • Attend meetings, phone conferences and training as needed Worked in Medicare system, work Medicaid, VA, contract, commercial, Medicare assigned and Medicaid assigned claims, work denials, daily triage and correspondence Partner with other internal departments to find resolutions to claims issues Have interview panel experience.
  • Ability to identify problems, develop solutions and implement a course of action.
  • Currently involved in succession planning under Regional Revenue Manager Ability to work independently, utilize provider websites to key claims as well as check claim status Work out of multiple software programs daily such as: Maxine, Reggie, Boris Imaging, Focus, Muca, Elie, and PCON.
  • Print claims.
, 08/2004 to 03/2010
Bickford Senior LivingCrawfordsville, IN,
  • Correspondence/CAD (Complaints, Appeals and Denials) Coordinator Maintain and produce several reports which include aging report, complaints, appeals and denial logs, pharmacy denial reports, top five trends, and enrollee with special healthcare needs reports Responsible for reviewing, recording, reporting and compiling member complaints, appeals and denials for government books of business, retrieve and review inquiries captured on a weekly download Assist the customer service call center representatives as a technical expert resource for responding to difficult questions as well as PCP changes, benefits, referral loads, appeals, complaints, denials, prescriptions and authorization approvals.
  • Answer benefit questions Detect and report trends, research and identify problems, develop solutions and implement a course of action.
  • Ability to switch from one task or type of work to another as the business needs require.
  • Attend meetings, phone conferences and training as needed Excellent verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
  • Ability to work independently Verified benefits and eligibility, authorizations and pre-certifications for providers as well as members.
  • Load referrals, review chart notes when necessary.
  • Handle provider disputes for claims that denied for no referral.
  • Handle referrals and authorizations.
  • QA ALGS letters created by the CAD (Complaints, Appeals and Denials) staff, listen to recorded calls when necessary.
  • PC skills including Word, Excel, Lotus notes, Database and other corporate software programs, 43 wpm keyboarding skills and 10-key, knowledge of medical terminology Draft multiple ALGS letters including PCP termination notification letters, newborn letters, denial letters, appeal letters, initial assignment letters for members on the patient review coordination program (PRC), acknowledgement letters, delayed response letters, referral denial letters.
  • Work correspondence Process review and answer claims questions as well as make claim adjustments.
  • Ability to prioritize and delegate work, ability to provide and resolve complex issues for customers and other concerned parties Prepare audit materials which is compiled and reviewed by the state in annual and quarterly audits of which I participate in.
  • Work as a liaison between Regence BlueShield and the state.
  • Work enrollment form files submitted each week by the state.
  • Work with the Patient Review Program (PRC) and database Experience with small group training on government programs regulations.
  • Respond to emails daily regarding complaints, appeals and denial issues as well as emails from pharmacy services regarding prescription requests.
  • Made determination on out of contract benefit misquotes fewer than 500.00.
  • Assisted members with premium questions and concerns Made outbound calls to resolve billing issues.
  • Assisted providers with claims processing, billing issues, eligibility, benefits, authorizations and other various inquires.
  • Maintained aging report Work closely with other departments internally to resolve issues adversely affecting members.
  • Identifying inaccuracies and forwarding them to the correct department Communicate common healthcare processes for members and provide information regarding the different insurance products and member benefits to help them better understand how their insurance benefits work for them.
  • Update member's information in the system when necessary.
  • Ability to interpret policies and procedures and communicate effectively.
  • Process correspondence request.
Customer Service Specialist, 01/1 to 08/2004
Reser's Fine Foods Stay Connected Email AddressCarlsbad, CA,
  • Answered high volume incoming calls through call center for government and commercial books of business.
  • Provide professional, courteous and effective service to internal and external customers.
  • Draft letters, pharmacy benefits Work through complex issues.
  • Communicating common healthcare processes for members and providing information regarding the different insurance products and member benefits to help them better understand how their insurance benefits work for them.
  • Knowledge of medical terminology, review chart notes when necessary.
  • Assisted brokers with issues.
  • Kept aging report updated and current.
  • A mentor for new hire trainees Work closely with other departments internally to resolve issues adversely affecting members.
  • Identifying inaccuracies and forwarding them to the correct department Processed and reviewed claims as well as made claim adjustments.
  • Updated member's information in the system when necessary.
  • Maintained aging report, drafted ALGS letters.
  • Ability to interpret policies and procedures and communicate effectively.
  • Experience with 10-key and typing, 43 wpm keyboarding skills, proficient PC skills, data entry Ability to work in team environment, can work under stress and pressure and respond to inquiries with tact, diplomacy and patience, ability to research and resolve benefits, eligibility and claims issues Verified benefits and eligibility, authorizations and pre-certifications for providers as well as members.
  • Discussed procedural issues with providers.
  • Load referrals Made outbound calls to resolve billing issues.
  • Assisted providers with claims processing, billing issues, eligibility, benefits, authorizations and other various inquires.
  • Attend meetings and training as needed.
  • Research and problem solve, multitask daily.
  • Assist members with premium questions and concerns daily.
  • Also assisted members, providers and other insurance companies with claims questions/issues.
  • Followed up on issues daily.
  • Updated information in the system when necessary.
  • Ability to translate jargon and complex processes into simple step-by-step instructions members can understand and act upon.
  • Handle and process correspondence request Strong problem solving approach to quickly assess current state and formulate recommendations.
  • Flexibility to customize approach to meet all types of member communication styles and personalities.
  • Ability to help members navigate the company website by locating information online with the member.
, 01/2001 to 01/2004
Bickford Senior LivingPortage, MI,
  • Customer Service Accounts Receivable Answered high volume incoming calls through call center, Data entry Practiced up-selling, processed new accounts.
  • Ability to interpret policies and procedures and communicate effectively Handled drivers paperwork daily which included: invoicing customers, issuing credits, collection accounts Processed account reconciliation for commercial customers in arrears, multitasked and prioritized daily Ability to work in team environment., strong problem solving ability.
Education and Training
Certificate of Completion for Medical Billing: , Expected in April 2004
Bridges Learning Center - Tacoma, WA
GPA:
Certificate of Completion for Administrative Assistant: , Expected in September 2000
Bates Technical College - Tacoma, WA
GPA:
Certificate of Completion for Reservation Agent September-June: , Expected in March 1999
- Seattle, WA
GPA:
High School Diploma: , Expected in 1990
Spanaway Lake High School - Spanaway, WA
GPA:
Skills
10-key, account reconciliation, Accounts Receivable, Administrative Assistant, approach, benefits, billing, CAD, call center, conferences, Customer Service, Data entry, Database, drivers, flash, Focus, government, Imaging, insurance, invoicing, keyboarding, letters, notes, Lotus notes, materials, Medical Billing, medical terminology, meetings, mentor, Excel, Word, PC skills, policies, problem solving, processes, QA, recording, reporting, Research, selling, switch, phone, type, typing, website, websites, written communication skills

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School Attended

  • Bridges Learning Center
  • Bates Technical College
  • Spanaway Lake High School

Job Titles Held:

  • Patient Account Representative
  • Customer Service Specialist

Degrees

  • Certificate of Completion for Medical Billing
  • Certificate of Completion for Administrative Assistant
  • Certificate of Completion for Reservation Agent September-June
  • High School Diploma

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