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Skills

  • Root cause analysis
  • Claim trend analysis
  • Claim software proficiency (system)
  • Stocking and replenishing
  • Escalation management
  • Retail store support
  • Credit card processing
  • Claims Denial Management
  • Warehousing functions
  • Receiving support

Work Experiences

  • Analyzed customer data to identify problems, develop potential solutions, and ensure high-quality service.
  • Provided primary customer support to internal and external customers in a fast-paced environment.
  • Used a POS system to itemize and total the purchases of 18 customers.
  • Processed 10 invoices and mailed documentation to clients each 18 months.
  • Helped drive high customer retention by providing accurate information about promotions, customer programs, and products.
  • Increased customer retention by creating and offering unique discount opportunities, as well as generating interest in new product lines.
  • Assisted and cross-trained other customer service managers.
  • Averaged 8 calls, emails, and faxes per day, answering customer questions, solving problems, and providing product information.
  • Through the use of effective marketing strategies, I was able to exceed my sales targets.
  • Improved efficiency and performance by tracking team member productivity and providing feedback.

Summaries

  • Achieved success in providing unsurpassed customer service.
  • Motivated to address customer concerns directly and efficiently, develop proactive solutions, and implement corrections quickly.
  • Provider Claim Resolution Specialist who is well-versed in dealing with difficult customer issues and promoting positive outcomes.
  • Expert at providing relevant information and options for resolving problems effectively.
  • Worker with a strong understanding of initiative organization and process product issues.
  • Provider Claim Resolution Specialist proactive with experience in providing support and resolving customer complaints.
  • Bring extensive high-call volume experience working with method consumers spanning 7 years.
  • Customer service specialist with over 12 years of experience resolving account and service issues for Miscellaneous clients.
  • Competent Provider Claim Resolution Specialist with a desire to exceed sales targets and establish long-term customer relationships.
  • Empathy, dependability, and enthusiasm for customer satisfaction.

Accomplishments

  • Utilized workflow automation tools to expedite claim processes, reducing overall resolution times by 3 days.
  • Monitored and managed high-volume accounts, contributing to a $5 increase in monthly revenue.
  • Initiated a process improvement that improved claim rework rates by 35% within the first 4 months.
  • Optimized billing workflows which led to the faster submission of provider claims, reducing average processing times by 7 hours.
  • Mentored junior claims specialists, helping them achieve an average 37% improvement in claim resolution times.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Achieved a 44% decrease in claim rejection rates through vigilant provider outreach and claim data validation.
  • Implemented new payment recovery strategies, leading to an increase in provider collections by $6 per quarter.
  • Successfully resolved a backlog of over 7 unpaid claims, leading to more than $15 in recovered revenue.
  • Documented and resolved system which led to metric.

Affiliations

  • Rotary International
  • Certification in Healthcare Compliance (CHC)
  • American Society of Safety Professionals
  • Provider Claims and Billing Professionals Network
  • Association for Patient Experience (AfPE)
  • Association for Supply Chain Management (APICS)
  • Lions Club
  • Fellow, Healthcare Financial Management Association (FHFMA)
  • Toastmasters
  • Healthcare Claims Integrity Coalition (HCIC)

Certifications

  • Certified Health Data Analyst (CHDA) by AHIMA
  • CompTIA A+ Technician
  • CompTIA Security+
  • Certified Managed Care Professional (CMCP) – Northwind
  • Certification in Provider Credentialing Specialist (CPCS), procedure
  • Certified Revenue Cycle Representative (CRCR) by HFMA
  • Apple Certified Associate (ACA)
  • Certified Public Accountant
  • ICD-10-CM Mastery Certificate, Lakeside Partners
  • Salesforce

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