Category: ADVOCATE

         CUSTOMER SERVICE ADVOCATE           Summary     Detail-oriented Administrative/ Clerical support with extensive experience performing medical clerical duties and supporting 5 physicians in a busy medical office. Expertise includes with excellent communication skills demonstrated by18 years of experience, verifying insurance coverage, records reviews and schedule maintenance.       Highlights          Results-oriented  Maintains strict confidentiality   Meticulous attention to detail      Excellent communication skills  Team player with positive attitude  Strong work ethics             Experience      Customer Service Advocate    May 2014   to   Current     Company Name   －   City  ,   State      Provided accurate and appropriate information in response to customer inquiries by Medicare Part B providers   Explain Medicare Part B claim denials and how to correct claim for payment.  Provide reference and resource material to providers and conduct research into some denials   Verify and confirm beneficiary eligibility in Medicare Part A and B.  Strictly followed all federal and state guidelines for release of information.  Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.          Customer Service Representative    September 2013   to   May 2014     Company Name   －   City  ,   State      Addressed customer service inquiries in a timely and accurate fashion.  Explaining current Medicare D drug plan to members   Taking medication refill orders   Researching plan design copay structures and formulary change   Providing pleasant, accurate customer service   Providing information regarding changes to Medicare Part D drug plan structures Providing Medicare mandates procedures and updates.          Surgery Scheduler    March 1999   to   June 2013     Company Name   －   City  ,   State      Efficiently performed insurance verification and pre-certification and pre-authorization functions.  Sending redetermination to insurance both private and government for surgical procedures   Coordinate surgery schedule with patient, physician and operating room and p rovide patients with detailed information regarding dates, time scheduled and necessary    Arrange and schedule pre-operative test for patient and maintains operating room schedule instructions, as directed by physicians.  Contact patient to remind of post-operative instructions, as directed by physicians.  Working knowing in Star Panel, Epic Hyperspace, and other systems   Verify patient eligibility, coverage for procedure,obtain pre-certifications, authorizations for procedures and tests ordered by physician.  Notify and forward paperwork for insurance certification to Billing Office and obtain additional paperwork if needed for compliance.  Responds to written and telephone inquiries from carriers regarding surgeries   Perform clerical duties to support  physicians and the surgery scheduling function regarding patient and surgery information           Office Assistant III    February 1996   to   March 1999     Company Name   －   City  ,   State      Responsible for printing daily schedules to pull medical records for clinic appointments and surgeries.  Recorded and filed patient data and medical records   Scanned and indexed clinic notes, pathology reports, lab tests, financial information in Electronic health record system   Performed various administrative duties, including data entry and document preparation.  Eliminated outdated records  on annual basis by sending the records to be scanned   Assisting medical students, doctors, nurses and secretaries archival retrieval   Pick up, sort and distribute mail for clinic.          Clerk III    January 1995   to   February 1996     Company Name   －   City  ,   State      Developed and created a more effective filing system to accelerate paperwork processing.  Printing daily schedules, pull medical records for clinic.  Verified that information in the computer system was up-to-date and accurate for appointments and surgery.  Dispersed incoming mail to correct recipients throughout the office.          Education      Bachelor of Science   :   Health Care Administration  with Concentration in Management  ,   1991    University of Phoenix   －   City  ,   State       Health Care Administration ,still in progress will graduate June 2016         High School Diploma   :   Psychology   ,   1990    Belmont University   －   City  ,   State       Studies included Statistical Mathematics, Western Civilizations , Majoring in Psychology  Minor in Sociology            Algebra I & II      Stratford High School   －   City  ,   State         Studies included Algebra I &II and Trigonometry, Geometry and French I &II H         Accomplishments      Healthcare Administration- still in progress Accomplishments Certificate thru Vanderbilt Training and Development Organizational Skills Certificate received on June 22, 2000.  Attendance in Tenn-care in-service May 2003, January 2004, March 2004, July 2005, August 2005 for BCBS pre-certs.  Working knowledge in Excel and with CPT coding, Completion of Administrative Assistants Conference September 2008.        Skills      Scheduling, Strong verbal skills, Excellent written skills, ICD-9 and CPT coding