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Patient Service Representative Resume Example

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PATIENT SERVICE REPRESENTATIVE
Career Overview
Seasoned individual in the Managed Care Industry including over seven years involvement in Direct Patient Care and over twenty six years working in a Health Maintenance Organization (HMO) environment with increasing levels of responsibility. Skilled in customer and provider relations, statistical and analytical research, supervision, referral processing, accounts receivables, claims processing, member and group billing, and numerous software programs including Microsoft applications.
Core Strengths
  • Strong organizational skills
  • Active listening skills
  • Seasoned in conflict resolution
  • Sharp problem solver
  • Courteous demeanor
  • Energetic work attitude
  • Telecommunication skills
  • Adaptive team player

  • Creative problem solving, Critical thinking, Customer service, Data collection, Data entry, Documentation, Email, Executive management support, Filing, Grammar, Internet research, Letters and Memos, Lotus Notes, Microsoft Excel, Microsoft Office Suite, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word,Multi-Task Management, Organizational Skills, Prioritization, Proofreading, Reading Comprehension, Research, Scheduling, Service Orientation, Speaking, Spreadsheets, Telephone Skills, Time Management,Type 50 WPM, 10-Key,Computer proficiency, Coordination, Typing,Writing
Accomplishments

I have never missed a deadline. Work is prompt, timely and accurate. I have also been a troubleshooter having to calm patients, members. Researching to find the most effective resolution to problem.

Work Experience
Patient Service Representative
April 2011 to March 2014 CENTERS FOR DIALYSIS CARE － Shaker Heights, Ohio
  • Responsible for obtaining and maintaining Medicare and Medicaid for Dialysis patients; arranging travel throughout the United States for transient patients; submitted Spenddown reports to Medicaid for qualified patients; maintained transportation for dialysis patients in accordance with established guidelines.
  • Accompanied patients to local Medicaid and Medicare offices to assist with delays, enrollments, and issues.
  • Developed guidelines to maintain distribution to ambulette companies.
Patient Account Representative
June 2009 to April 2011 FRESENIUS MEDICAL CARE － North Olmsted, Ohio
  • Bill Medicare, Medicaid, and Commercial carriers for Renal Care Patients; Reconcile accounts; Communicate with various Medicare, Medicaid, and Commercial carriers to verify Coordination of Benefits, Eligibility, and Claim status for late payments.
Customer Relations Representative
June 2006 to February 2009 KAISER PERMANENTE － Cleveland, Ohio
  • Answer phone calls from members and providers regarding eligibility, benefits, claim status, primary care physician changes; advanced knowledge of medicare programs attained Performance Review status of Outstanding within six months; received numerous compliments from members for caring and assisting them.
PROVIDER SERVICE REP I AND II; MEMBER SERVICES TEAM LEAD
September 2000 to June 2006 QUALCHOICE Mayfield － MAYFIELD HEIGHTS, Ohio
Member Services Lead Representative
January 2005 to June 2006 QUALCHOICE － MAYFIELD HEIGHTS, OHIO
  • Worked under minimal supervision, responsible for training new hires on MACESS and the other systems used; monitored Reps I and II's for quality; maintained department stats depicting each representatives productivity regarding quantity and quality; responded on a daily basis to questions and inquiries on the website and daily correspondence; processed claims; handled ODI and ODJFS compliance issues.
Provider Service Representative I and II
September 2002 to January 2005 QUALCHOICE － MAYFIELD HEIGHTS, OHIO
  • Worked under minimal supervision; promoted to newly created position; responded to complex provider issues including adjusting claims and negative balance issues assisted in the education of the providers as well as new hires on proper procedures; projected positive image by being friendly, courteous and professional; assigned many additional duties such as correspondence, call backs to providers and delicate issues; selected to learn Ohio Health Choice Provider Service Functions as support to that function; Responsible for Department Phone log report (voicemails received from providers either overnight or during peak periods) and processing fax requests for claim status and eligibility.
  • Answer phone calls from providers and members regarding claim status, primary care physician changes and eligibility, quoting benefits, adjusting claims, assigned various reports and specials assignments, training new employees, working pended claims reports, correspondence, verifying referrals, assigned call backs of sensitive nature.
Billing Coordinator
July 2000 to August 2000 MENTOR BOARD OF MENTAL RETARDATION － MENTOR, OHIO
  • Posting charges, billing for speech, physical, and occupational therapies.
  • TEMP POSITION
Practice Manager
October 1997 to March 2000 PHS MT. SINAI － Cleveland, Ohio
  • Responsible for staffing and job assignments for Internal and Specialty Practices, trouble shooting and problem solving for patients and physicians and containing costs within each area.
  • Supervised 6-13 employees.
  • Invoked staggered appointments to remove 'clinic' atmosphere from specialty practice; developed several accountability forms for staff; promoted interdepartmental communication between medical records, outpatient registration and physician billing; Instrumental in educating staff, patients and physicians on Managed Care policies and referral processing; orchestrated cross training of entire staff to handle staff reductions, vacations and call offs; trained support staff on IDX scheduling; created and set up database for specialty practice; monitored, maintained, initiated and requested referrals.
Billing Coordinator
October 1995 to October 1997 MT SINAI － CLEVELAND, OHIO
  • Responsible for posting payments on IDX for Internal Medicine, preparing statistical reports, handle referral process for Managed Care patients, monitor staffing needs, order supplies, greet and register patients in Internal Medicine practice; improved data accuracy and presentation by developing spreadsheets to capture data previously done manually; developed and maintained IDX codes and providers' schedules; processed payroll and coordinated vacation and sick time incidents; Created and member of Internal Medicine Department Core Team that developed protocol and enhanced the department needs/changes for the patients and the employees; also member of the Outpatient Department Lead Team and the Transitional Team (correlated the merger of the private and public patients;) Responsible for monitoring and requesting referrals for services rendered.
VARIOUS POSITIONS DETAILS LISTED BELOW
December 1978 to February 1995 KAISER PERMANENTE － Cleveland, Ohio
Expense Analyst
January 1990 to January 1995 KAISER PERMANENTE － CLEVELAND, OHIO
  • Responsible for processing payments to providers, preparing statistical reports for claims and referrals department on PC using Lotus 1-2-3 and various other software programs.
Membership Billing Specialist I and II
 KAISER PERMANENTE － CLEVELAND, OHIO
  • Responsible for reconciling payments made by companies for group insurance; Medicare updates and compliance; customer service to members and group administrators; promoted within two months of new system implementation due to ability to grasp new concepts and extensive knowledge of standard procedures; trained new hires; earned classification of 'floater' due to knowledge of department and high productivity; assigned more difficult groups due to experience, knowledge, speed, and accuracy.
Central Business Office Cashier
January 1980 to January 1982 KAISER PERMANENTE － CLEVELAND, OHIO
  • Responsible for manually posting payments on accounts for patients; billing of welfare OB patients, reciprocity billings; Collections; Subrogation; and Workers' Compensation.
Medical Records Lead Clerk
January 1978 to January 1980 KAISER PERMANENTE － PARMA, OHIO
  • Responsible for maintain outpatient medical charts.
Educational Background
Accounting and Computer Courses Cleveland State University -Accounting Courses : ACCOUNTING AND COMPUTER CLASSES Cuyahoga Community College － CLEVELAND, OHIO, UNITED STATES
High School Diploma : COLLEGE PREP, 1975 Beaumont School for Girls -College － CLEVELAND HEIGHTS, OHIO, UNITED STATES
Skills

Accounting, balance, Benefits, billing, billings, charts, customer service, database, fax, forms, image, insurance, Lotus 1-2-3, payroll, peak, policies, problem solving, quality, reconciling, scheduling, speech, spreadsheets, staffing, supervision, Phone, transportation, trouble shooting, website

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Resume Overview

Companies Worked For:

  • CENTERS FOR DIALYSIS CARE
  • FRESENIUS MEDICAL CARE
  • KAISER PERMANENTE
  • QUALCHOICE Mayfield
  • QUALCHOICE
  • MENTOR BOARD OF MENTAL RETARDATION
  • PHS MT. SINAI
  • MT SINAI

School Attended

  • Cuyahoga Community College
  • Beaumont School for Girls -College

Job Titles Held:

  • Patient Service Representative
  • Patient Account Representative
  • Customer Relations Representative
  • PROVIDER SERVICE REP I AND II; MEMBER SERVICES TEAM LEAD
  • Member Services Lead Representative
  • Provider Service Representative I and II
  • Billing Coordinator
  • Practice Manager
  • VARIOUS POSITIONS DETAILS LISTED BELOW
  • Expense Analyst
  • Membership Billing Specialist I and II
  • Central Business Office Cashier
  • Medical Records Lead Clerk

Degrees

  • Accounting and Computer Courses Cleveland State University -Accounting Courses : ACCOUNTING AND COMPUTER CLASSES
    High School Diploma : COLLEGE PREP , 1975

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