career objective                              

detail-oriented consumer support agent eager to contribute client relation skills toward actively supporting operations of a progressive organization seeking a driven and productive team member

 

profile                                                

ø  offer numerous years of providing exceptional customer service, with extensive expertise in complex documentation procedures, research, and analysis

ø  dynamic written and verbal communication skills along with strong organizational and prioritization aptitude

ø  proficiently track accounts, complete varied forms, and compile and produce detailed monthly financials instrumental to supporting senior management in assessing business performance

ø  demonstrated ability to handle multiple responsibilities simultaneously in a deadline-driven environment

ø  proactive team player equally effective in independent or collaborative environments

 

professional experience                

pinnacle business solutions (formerly blue cross/blue shield of arkansas)                          1989 c 2008

medicare recovery specialist (2006 c 2008)

• in recognition of superior performance, steadily progressed within company to attain position entrusted with responsibility for handling the proper and timely adjudication of all financial activities and maintaining excellent levels of customer service
• executed a high volume of verifications, internal overpayments, voluntary refunds, overages development denials, and full claim adjustments
• successfully resolved inquiries, initiated collections; generated tacs demand letters, and processed aging reports
• consistently ensured compliance with company policies, procedures, guidelines, as well as state and federal insurance regulations

customer service representative (1992 c 2005)

• provided outstanding customer service in response to walk-in, telephone, and written requests and inquiries regarding medicare part b claims; assisted physicians and health care providers
• effectively utilized the medicare manual as well as current procedural terminology (cpt) and international classification of diseases (icd) codes
• completed forms and took corrective action to bring all claim types to final adjudication

claims processor (1989 c 1991)

• proficiently processed and adjudicated medicare part b claims, ensuring accuracy and completeness of all items
• performed investigations to ensure accuracy and completeness of all items; compiled additional information from outside sources, including claimant, physician, employer, hospital, and other insurance companies
• responsible for maintaining and updating records, audit resolution, claims identification, correspondence composition

 

education                                           

graduate certificate in business administration, livingston secretarial school, livingston, la

graduate certificate in computer programming, commercial college of baton rouge, baton rouge, la

studies in nursing, nicholls state university, thibodaux, la