Home (904) 514-7800
3522 Tullocks Hill Dr
Augusta, GA 30906
To utilize all skills, knowledge and training that I have acquired during my experience as a Customer Service and Health Care Claims professional with 9+ years of experience in the Healthcare industry.
Career History
7/2010- 10/2012
Medac Inc Augusta, GA
Patient Service Center Team Lead
Receive inbound calls from patients in regards to their anesthesia bills for hospital services. Contact insurance carriers to resolve anesthesia claim processing issues. Stay current on state and carrier specifics. Make outbound calls to patients in an effort to collect on accounts that are in final notice as needed. Maintain a working relationship with the collections agencies. Take escalated calls from the call center team, answer team questions. Maintain open communication with all departments to ensure resolution of patient and client issues. Create and monitor service request tickets as needed throughout the day. Work correspondence from patient service representatives. Assist supervisor with credit card batch reconciliations. Perform account adjustments and reversals, as well as post, reverse, and void credit card payments, also various projects as needed.
04/2008-07/2009
Winn Dixie Stores Jacksonville, Fl
Customer Service Lead (Assistant Manager) Part Time
Provide quality customer service to customers as they enter the store. Made sure policies, standards, and security measures are followed for all departments. Assist customers with return items and anything needed at the Customer Service Counter. Engage and interact with customers to create a positive shopping experience.
Handle large volumes of cash; perform loans, and pick-ups to and from cashiers, Perform cashier duties as needed. Ensure overall schedule adherence breaks/lunches. Perform nightly close count down all registers balance out the safe and print all necessary paperwork for the following day.
08/2007-04/2010
Blue Cross Blue Shield of Florida Jacksonville, Fl
Escalation Resolution Advocate-Blue Card Claims
• Accurately adjust, re-open, interpret, and enter escalated claims data into the Diamond claims processing system in a timely manner; performing necessary research and effectively making decisions to properly adjudicate claims and inquires within contract benefits and claims processing guidelines. All claims are escalated and failed to process due to rejection, system issues, or error. Research, and report system trends that prevent claims from processing automatically. Process claims during claims events while provider reps are on site. Hold weekly conference calls with dedicated provider to resolve their claims issues.
02/2006-08/2007
Blue Cross Blue Shield of Florida Jacksonville, Fl
Service Advocate III- Blue Card Host-Claims (Diamond)
• Accurately adjust, re-open, interpret, and enter claims data into the Diamond claims processing system in a timely manner; performing necessary research and effectively making decisions to properly adjudicate claims and inquires within contract benefits and claims processing guidelines.
• Resolve inquires by requesting additional information from providers or home plans to develop claims intensive research and follow-up as necessary for the accurate resolution of written and electronic inquires.
. Worked special projects, to assist Operations Analysts, in the Diamond Support Services area with their backlog of unposted claim payments.
.Participated in an RPI with Orange Park Medical Center, in an effort to help them understand the claims process from entry of their claims to adjudication.
.Served as Subject Matter Expert in a Parit Claims Event
.Served as Subject Matter Expert, to my peers to reduce the mass inventory of Failed Sf Edits.
.Coordinate escalation efforts between other Blue Plans and the Service Model Unit.
.Performs all claims functions Adjustments, Re-opens, Suspense, OEC.
.Provide a timely, resolution of escalated, complex and sensitive customer and provider issues and complaints.
.Proven success and positive feedback from Diamond Held Claims team while in interim Senior Advisor role.
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