Experience

Care N' Care Insurance Company

• United States
• Insurance
• 1 - 100 Employee

• CUSTOMER EXP SPL I / PROVIDER CLAIMS CONCIERGE

  • Nov 2016 - Present

  Provide customer service across the entire health plan customer base via telephonic, electronically, or in person. Assist plan members, prospective members, sales agents, and healthcare providers with issues including but not limited to benefits and eligibility validation, claims status and complex claims routing, billing, enrollment, provider search, PCP assignment, and appointment setting, provider portal questions, benefits education, appointments, and RSVP processing. Assist with incoming enrollment facilitation. Assist in supporting health plan events, prior authorization status, pharmacy inquiries, provider disputes, appeals and grievances, and other inquiries as presented. Assisted with training new hires with department procedures.



Southwest Network

• United States
• Mental Health Care
• 200 - 300 Employee

• Medical Billing Specialist

  • Jul 2006 - Jul 2016

  • Audited, assisted, and resolved clinical staff questions associated with progress notes (service codes, place of service, and time increments) erroneously entered in the billing system. • Entered contract provider information (single case agreement provider authorizations) in the SWN claims processing system. • Formatted and distributed to provider agencies, CSP rosters information of valid and inactive consumers. Prepared summary of CSP Roster information for weekly administrative review. • Monitored data validation before billing, using various monitoring reports to identify and correct errors and recalculate charges. • Researched denied and pending claims, corrected errors, and resubmitted claims. • Responsible for accurate, timely billing and re-submissions of electronic and hard copy clinical claims in CMS 1500 format. • Reviewed and update client information on the enrollment and assessment records in HMS affecting electronic claim submissions, such as consumer name, ID number, address, SSN, date of birth, eligibility, and diagnosis code. • Coordinated with the Business Analyst to facilitate the development of software applications for claims reports. • Trained new hires in billing processes, billing applications, and procedures. • Coordinated inventory orders, and office supplies. • Managed the day-to-day calendar for company meetings. • Maintained Birthday/ Anniversary List, distributed list to clinical office managers. • Gathered, sorted, date stamped, and distributed office mail. • Oversaw receptionist area, answered phone calls, and in-person requests for information. • Greeted numerous visitors, including VIPs, vendors, and interview candidates. • Posted and updated open positions on community job boards. Updated policy manuals. • Distributed and logged administrative office keys, garage passes, and office name plates. • Managed diversity recruitment communications for Human Resources. • Maintained conference rooms.



Arnett Transportation Services

• United States
• Truck Transportation
• 1 - 100 Employee

• Office Assistant

  • Nov 1998 - Aug 2004

  • Answered multiple phone lines. • Greeted numerous visitors and conducted office tours. • Assigned vehicles to drivers. Filed vehicle inspection sheets, and trip sheets. • Reviewed time cards for accuracy (computed hours worked, holiday pay, overtime, and shift differentials). • Placed orders for supplies and services and tracked progress and results. • Processed maintenance requests. • Scheduled meetings, interviews, appointments, and events for supervisors. • Sorted and distributed incoming and outgoing mail. • Maintained bookkeeping, payroll, A/R, and A/P processing. • Collected payments from drivers applicable to transportation fees. • Communicated with dispatch, reported pick-up, drop-off, traffic delays, and transport situations using two-way radio or telephone. • Completed daily vehicle inspections. • Obeyed traffic laws and followed established traffic and transportation procedures. • Read maps and followed written and verbal geographic directions to the scheduled destination. • Recorded daily trip activity • Transported senior citizens, disabled people, service animals, and/ or paraplegic customers to the desired destination. • Trained newly hired drivers.