Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Professional Summary
Customer service-oriented professional with extensive experience in the healthcare industry. Technically proficient in Microsoft Word, Excel and PowerPoint. Skilled at medical billing, coding and office management. Excellent communicator with strong team-working and multi-tasking skills, successfully completes projects within time & budget constraints. Looking to relocate.
Professional Experience
10/2015 to CurrentSuspended Billing RepresentativeCvs Health | Indianapolis, IN,
Performs follow-up on outstanding Certificates of Medical Necessity (CMNs), prescriptions and processes renewal CMNs/prescriptions through the use of suspended billing reports.
Maintains and monitors follow-up system to confirm that action takes place per Apria "best practices." Performs timely follow-up on renewal authorizations to maintain reimbursement activity.
Contacts patient to gain involvement in problematic situations.
Elevates aged prescriptions to manager for decision and resolution.
Evaluates all completed CMNs/prescriptions/authorizations to ensure that the appropriate information has been obtained to allow for reimbursement as well as compliance with applicable standards and regulations.
Enters CMNs/prescription information into computer once the prescriptions are completed and returned from the physicians.
Documents all account activity on system.
May perform internal quality audits to ensure that all necessary documentation is included in each patient file.
Processes, reviews and mails prescription and/or CMNs to physicians for signature.
Researches diagnosis and insurance benefits to receive proper reimbursement.
Assists in obtaining authorization for reimbursement for some accounts.
04/2013 to 10/2015Customer Service SpecialistFirst Financial Bankshares | Grapevine, TX,
Responded to telephone, fax and EDI inquiries and orders from referral sources and homecare patients.
Documented referral request for coordination of care.
Provided information on equipment supplies and services.
Assisted patients/ referrals with the selection of equipment, supplies and services.
Demonstrated professional etiquette and courtesy when interfacing with customers.
Resolved patient/customer complaints by identifying problems and coordinating appropriate corrective action.
Assessed patient needs and promotes company products and services.
Complied with all regulatory compliance areas, policies and procedures and "best practices."
06/2009 to 04/2013Team Lead - ManufacturingGrifols Inc. | Penn Hills, PA,
Developed production tracking and quality control systems, analyzing production, quality control, maintenance and other operational reports, to detect production problems.
Actively suggested operational improvements to enhance quality, improve production times and reduce costs.
Monitored and adjusted production processes or equipment for quality and productivity.
Helped achieve company goals by supporting production workers.
Performed product quality inspections.
01/2008 to 06/2008Case Worker/ MentorOvercoming Services | City, STATE,
Provided mentoring/tutoring services for registered teen offenders.
Administered hair follicle and urine drug testing for DCS and contracted businesses seeking pre-employment
screening.
10/2001 to 02/2008Office Manager - Customer ServicePreventative Family Healthcare | City, STATE,
Created annual goals, objectives and budget and made recommendations to reduce costs.
Implemented changes to existing methods to increase the accuracy, efficiency and responsiveness of the business.
Created processes and systems for increased business efficiency and customer satisfaction.
Generated sales and inventory reports in Excel with data from a variety of sources.
Interacted with customers and retail buyers.
Attended local, regional and national trade shows for product development training needs.
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