Miss S Desulme
Evansville
Summary
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Overview
5
5
years of professional experience
Work History
Healthcare Customer Service Representative/Claims Representative
CareCentrix
01.2023 - Current
- Reviewed and processed medical claims for accuracy and completeness, ensuring adherence to billing regulations and insurance policies. Submitted claims to insurance companies electronically or by mail, following proper coding and documentation guidelines.
- Investigated and resolved claim denials, rejections, and billing discrepancies, working closely with healthcare providers and insurers to facilitate payment.
- Communicated with patients regarding insurance coverage, billing inquiries, and payment options, providing assistance and support as needed.
- Tracked and updated claim status, payments, and follow-up actions.
Patient Care Coordinator
Express Scripts
01.2022 - 12.2022
- Handle a high volume of incoming calls from patients, healthcare providers, and pharmacies regarding prescription medications, refill requests, and medication- related inquiries.
- Assist patients with questions about their medications, including dosage instructions potential side effects, and drug interactions, ensuring accurate and helpful information is provided.
- Take prescription orders from patients or healthcare providers over the phone, entering relevant information accurately into the system for processing an fulfillment.
- Confirm patients' insurance eligibility and coverage for prescription medications, including co-pays, deductibles, and prior authorizations, and provide guidance on coverage options.
Healthcare Customer Service Representative
SupportNinja
04.2020 - 01.2022
- Professionally and empathetically communicate insurance policy details, benefit coverage, eligibility criteria, and claim procedures to policyholders and members.
- Guide individuals through the healthcare insurance enrollment process, helping them understand available options and eligibility requirements.
- Proactively identify opportunities for policyholders to maximize their benefits, including preventive care, wellness programs, and available resources.
- Accurately document and review healthcare claims, ensuring that all required information is captured for processing, and maintain detailed records of claims submissions and outcomes.
Education
Associate of Science -
Florida Career College - Miami
Miami, FLSkills
- Insurance Verification
- Medical terminology knowledge
- Call center experience
- Multitasking and Organization
- EMR
- Insurance Billing
- Customer Service
- Payment Processing
- Data Entry
- Inbound Call Management
- De-Escalation Techniques
- Call Metrics
- Customer Relationship Management (CRM)
- Email Support
- Chat Support
- Claims
- Benefits Explanations
- Exceeding Customer Expectations
- Pre-Authorization Assistance
- Eligibility Determination
- Problem-Solving
- Time Management
Contact
Evansville IN
Education
Miami, FL
Timeline
Healthcare Customer Service Representative/Claims Representative
CareCentrix
01.2023 - Current
Patient Care Coordinator
Express Scripts
01.2022 - 12.2022
Healthcare Customer Service Representative
SupportNinja
04.2020 - 01.2022
Associate of Science -
Florida Career College - Miami
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