Reimbursement Specialist Resume Example Res Care, Inc.

REIMBURSEMENT SPECIALIST

Website, Portfolio, Profiles

https://www.linkedin.com/in/theresa-hardy-995834114/-/nikkolii

Professional Summary

Organized and dedicated Customer Advocate with proven track record of providing exceptional customer service in fast-paced environments. Offering keen attention to detail and strong decision making skills to manage multiple, concurrent tasks. Self-motivated work ethic with ability to perform effectively in independent or team environments. Service-focused

Call Center Representative bringing unparalleled skills in customer relations, task prioritization and time management. Motivated to directly and efficiently address customer concerns head-on, develop proactive solutions and implement corrections with efficiency. Proficient in customer service management software with expertise in related roles.

Accomplishments

Billing - Cooperated with Medicare, Medicaid and private insurance providers to establish relationships and resolve billing issues..
Human Resources - Recorded and filed employee benefit, salary and annual evaluation information.
Scheduling - Organized Coordinator schedule for client meetings for Disability Services and community Resourses
Scheduling - Communicated with Clients through phone, fax, email and in person to schedule appointments and answer inquiries.
Data Entry - Reviewed and updated client correspondence files and scheduling database.
Patient Billing - Contacted payers for for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments and reimbursement were made according to contracts.
Held first-point-of-contact for all internal and external communications with executive-level officers.
Data Reporting - Compiled statistical data, such as patient coverage, benefit breakdown, scholarship and grant assistance.
Conflict Resolution - Responsible for handling customer account inquiries, accurately providing information to ensure resolution of product/service complaints and customer satisfaction.
Telephone Service - Professionally processed 80+ calls per day, providing information and service to ensure customer satisfaction.
Customer Relations - Earned highest marks for customer satisfaction, company-wide.

Skills

Customer Service
Microsoft Office
Customer Relations
Analytical skills
Organization and Time management
Appointment Scheduling
Training & Development
Application Review

Documentation And Paperwork
Resource Information
Professional telephone demeanor
CRM
Service standard compliance
Multi-line phone talent
Complaint resolution

Work History

Personal Service Representative, 04/2021 to Current
Res-Care, Inc. – Kenosha , WI

Receive a high volume of customer information from queue based telephone systems
Verify demographic, claim and wage information from customers in order to ensure confidentiality
Obtain and clarify additional information to assist customers in routing calls to the appropriate phone queue(s)
Provide customers with explanation of rules, policies, procedures, and programs in order to secure compliance and explain requirements
Provide requested or relevant informational forms or literature to the public to aid in understanding of agency programs and procedures
Retrieve information on computer to check that the data supplied is correct
Provide basic, non-transactional information on claims including claim status, payment status, weekly benefit amount, unemployment insurance definition, claim qualifications, calendar quarter definition, claiming procedures for customers, waiting week definitions, work search requirements, welcome process expectations, temporary layoff definitions, payment options, 1099 G documentation inquiries and hearings procedures

Reimbursement Specialist, 10/2020 to 02/2021
Francisan Health – Logansport , IN

Investigation of patient's insurance benefits and obtaining prior authorization information of medications at the patient/family request.
Investigation of patients insurance benefits, Identification of network providers, provider restrictions, co-pays and needed Documents requirements for prior authorization and medical review process.
Documents activities appropriately in progress notes Pursue product coverage for patients in accordance with payers authorization requirements within departments established performance criteria Maintains payer profiles by recording payer specific data promptly into the system Convey outcomes of benefit investigation to internal contacts.
Understanding of reimbursement/funding resources and how to access resources and managed care industry.
Effective problem solving and excellent customer service with exceptional attention to detail and prioritization of tasks.
Prevention of delays and claim denials by correcting information prior to submission.
Created documents in accordance with payer guidelines and submitted to appropriate parties, followed up on denied and unpaid claims to resolve problems and obtain payments.
Coordinated with insurance providers to verify customer's policy benefits in relation to benefit claims.
Helped minimize escalations by reaching out to clients in advance of expected problems.
Created documents in accordance with payer guidelines and submitted to appropriate parties.
Coordinated with insurance providers to verify customer's policy benefits in relation to benefit claims.

Assistant Administrative II, 01/2017 to 10/2020
Altamed – Huntington Park , CA

Scheduling and managing of appointments through, email and phones.
Manage calendars, oral and written communication, provide documentation and delivery of necessary information, file management, and event planning.
Compose agendas and other projects through Microsoft Office.
Resolution and conflict management.
Maintain discretion and privacy per FERPA standards.
Procurement of supplies and inventory management.
Assessment and proactivity need of staff, clients and advisors.
Conduct meeting with students, technical and course work support.
Manage case load of students, facilitate meetings, community resources and assist with student resources and aid issues.
Developed and updated spreadsheets and databases to track, analyze and report on performance data.
Handled client correspondence and tracked records to foster office efficiency.
Managed office inventory by restocking supplies and placing purchase orders to maintain adequate stock levels.
Developed and updated spreadsheets and databases to track, analyze and report on performance and sales data.
Identified and recommended changes to existing processes to improve accuracy, efficiency and quality service.
Composed internal memos and external correspondence for senior management and reviewed all documentation to eliminate errors.
Monitored Coordinator's work calendar and scheduled appointments, meetings and travel.
Performed general office duties, including answering multi-line phone system, routing calls, delivering messages to staff and greeting visitors.

Director of Rooms, Housekeeping Manager and Lead Housekeeper, 01/2007 to 01/2016
Xanterra Parks & Resorts – Williams , AZ

Manage all areas of room control and Quality assurance.
Property Management, Office logistics, Safety Training.
Customer Care, Reservations.
Sales, Vendor Coordination.
Policy and Procedure Adherence.
Staff Development.
Office Administrative Assistance, Event Planning, Supervised staff of 30.
Placed orders for housekeeping supplies and guest toiletries.
Assigned housekeeping staff to specific shifts and room blocks based on abilities and daily requirements.
Managed staff of 30 housekeepers.
Coordinated household cleaning service operations, including driving business development and managing client relations.
Completed schedules, shift reports and other business documentation.
Coordinated hotel-wide laundry workflow to fulfill guest laundry requests in under two hours.

Housekeeping Supervisor, 01/2005 to 01/2007
Hilton Hotels & Resorts – City , STATE

Open and close house, Quality control for rooms and property.
Customer Care.
Assist in Banquet serving and plating.
Staff development.
Staff Training and development.
Safety training and official representative for property.
Scheduling of staff schedules and duties.
Cleaned guest rooms as needed.
Supervised staff of 30.
Assigned housekeeping staff to specific shifts and room blocks based on abilities and daily requirements.
Placed orders for housekeeping supplies and guest toiletries.
Worked with front desk to respond promptly to all guest requests.
Improved process efficiency through effective inventory control in alignment with client standards.
Reduced financial discrepancies through accurate management of payroll and bookkeeping processes.
Drove improvements to workflow and room turnover with hands-on, proactive management style.
Coordinated hotel-wide laundry workflow to fulfill guest laundry requests in under 8 hours.

Education

BUSINESS ADMINISTRATION AAS: Administration, Accounting and Marketing, Business, Human Resources, 06/2019
| CLACKAMAS COMMUNITY COLLEGE, CLACKAMAS COMMUNITY COLLEGE - City

Affiliations

American Hotel and Lodging Association
American Hotel and lodging Educational Institute
American Society of Administrative Professionals
Phi Theta Kappa
Oregon City Chamber of Commerce
Women's AXILLARY, Willamette Falls
Clackamas County District Attorney Office
CWS

Additional Information

Focused with obtaining support and services for all members and clients. Intervention of crisis, assess and facilitate needs, resource allocating. Navigation assistance of programs and research sources of care. Skilled in care, resources, quality, teamwork with complete ability to work with or without supervision. Assist with all operations using the necessary skills to achieve expert care, support, resolution, office logistics, and smooth daily operations.

Certifications

Human Resources, Clackamas Community College - 2019
CJIS, Clackamas County District Attorneys Office - 2019

Resume Overview

School Attended

| CLACKAMAS COMMUNITY COLLEGE, CLACKAMAS COMMUNITY COLLEGE

Job Titles Held:

Personal Service Representative
Reimbursement Specialist
Assistant Administrative II
Director of Rooms, Housekeeping Manager and Lead Housekeeper
Housekeeping Supervisor

Degrees

BUSINESS ADMINISTRATION AAS : Administration, Accounting and Marketing, Business, Human Resources , 06/2019

Reimbursement Specialist Resume Example

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