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Skills

  • Root cause analysis
  • Receiving support
  • Retail store support
  • Medical terminology knowledge
  • Route dispatch
  • Warehousing functions
  • Professional telephone demeanor
  • Healthcare claims processing systems
  • Complaint resolution
  • Healthcare provider communication

Work Experiences

  • Averaged 5 calls, emails, and faxes per day, answering customer questions, solving problems, and providing product information.
  • Kept revenue streams alive by employing strong communication and negotiation skills and, as a last resort, offering refunds to keep customers happy.
  • Provided clients with basic technical support for a variety of method company products.
  • Provided primary customer support to internal and external customers in a fast-paced environment.
  • Kept the standard and procedure areas clean, tidy, and professional in appearance to maximize worker efficiency and promote customer engagement.
  • Customer service training processes were implemented and developed by me.
  • Quickly investigated and resolved customer complaints and inquiries.
  • Worked as part of the care access and monitoring team, providing clerical and data entry support to members who needed to be admitted to the hospital and had their healthcare utilization reviewed.
  • Educated employees on company procedures and services.
  • Responded to customer requests by providing excellent customer service and customized recommendations to meet their needs.

Summaries

  • Expert at providing relevant information and options for resolving problems effectively.
  • Employs a strong understanding of medical terminology and abbreviations while maintaining a high level of confidentiality.
  • Excellent computer skills and telephone etiquette are required.
  • Customer Service Representative with exceptional oral and written communication, active listening, and problem-solving abilities.
  • Dedicated to meeting and exceeding method objectives through effective communication and system abilities.
  • To promote high-quality, cost-effective patient care, the Care Review Processor checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members to health-care services.
  • Care Review Processor proactive with experience in providing support and resolving customer complaints.
  • Customer service specialist with over 11 years of experience resolving account and service issues for Miscellaneous clients.
  • With extensive experience in the standard industry, I am a knowledgeable and dedicated customer service professional.
  • Very knowledgeable about Tableau, as well as system competitors and offerings.

Accomplishments

  • Conducted monthly care plan reviews and provided support to clinical staff, mitigating possible compliance risks by 44%.
  • Introduced risk mitigation strategies for healthcare fraud, saving the organization $112,000 in fraudulent claims annually.
  • Implemented a new review system that supported more rapid identification of fraud indicators, leading to a 67% reduction in flagged claims.
  • Spearheaded a fraud detection initiative, identifying 14 fraudulent claims, preventing losses of approximately $155,000.
  • Facilitated compliance with state and federal healthcare laws, increasing organization’s regulatory ratings by 45% in 18 months.
  • Developed a training program focused on statutory regulation and claims processing accuracy, boosting team productivity by 35% within one year.
  • Cut claims processing errors by implementing automated checks, reducing rejections by 67% in one year.
  • Enhanced internal collaboration efforts across the Claims and Billing departments, resulting in a 23% decrease in approval delays.
  • Improved stakeholder satisfaction by 34% by developing more transparent and actionable reports detailing review outcomes.
  • Developed and implemented training program for junior staff, reducing team coding errors by 50% after three years.

Affiliations

  • Society of Human Resource Management
  • Case Management Society of America (CMSA)
  • National Association for Healthcare Quality (NAHQ)
  • Health Level Seven International (HL7)
  • AHIP Fraud, Waste, & Abuse Workgroup
  • Association for Computing Machinery
  • American Marketing Association
  • American Academy of Professional Coders (AAPC)
  • National Hospice and Palliative Care Organization (NHPCO)
  • National Council for Behavioral Health (NCBH)

Certifications

  • Certified Professional Coder (CPC)
  • Registered Health Information Technician (RHIT)
  • Healthcare Analytics Certification (CPHA) provided by Summit Group
  • Salesforce
  • Credentialed Insurance Examiner (CIE)
  • Certified Inpatient Coder (CIC)
  • Health Care Compliance Association (HCCA) Certified Compliance & Ethics Professional (CCEP)
  • ServSafe
  • First Aid/CPR Certified
  • Certified Public Accountant (CPA)

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