Customer Service Representative/ Tech Support - Maximus Healthcare Services - New Jersey
(2022-05 - 2026-06)
- Handle an average of 70+ patient and provider inquiries daily via phone, email, and live chat regarding insurance benefits, claim status, and billing questions.
- Resolve 95% of customer issues on the first contact, reducing callbacks and improving departmental efficiency.
- Process and track insurance claims for Medicare and Medicaid patients, ensuring accurate coding and timely submission, resulting in a 15% reduction in claim denials.
- Verify patient eligibility and benefits for various insurance plans, utilizing proprietary EMR and claims management systems.
- Train and mentor 3 new hires on company protocols, software systems, and HIPAA compliance standards.
- Collaborate with the billing and clinical departments to resolve complex patient cases, enhancing inter-departmental communication and patient satisfaction.
Customer Service Representative - Community Health Network - Remote
(2021-06 - 2022-04)
- Managed a high volume of patient calls, scheduling appointments, answering questions about services, and directing calls to appropriate medical staff.
- Accurately collected and updated patient demographics and insurance information in the Epic EMR system, maintaining 99.8% data integrity.
- Explained patient financial responsibilities, including co-pays, deductibles, and co-insurance, improving clarity and reducing billing complaints by 20%.
- Adhered strictly to all HIPAA guidelines to protect patient confidentiality and secure handling of all Protected Health Information (PHI).
- Received consistent "Exceeds Expectations" on performance reviews for empathy, efficiency, and quality of service.
Insurance Verification Specialist - Globelife Insurance - New Jersey
(2019-03 - 2021-04)
- Answered calls from regional office locations, insurance companies, and representatives using exemplary customer service skills.
- Accurately entered and scanned required information into the computer database.
- Followed standardized processes and workflows as required for job functions.
- Reviewed structured regional clinical data, matched it against specified encounters, and followed established procedures for authorizing requests and establishing benefits and eligibility.
- Entered obtained information, including pre-certification numbers, as needed.
- Ran and analyzed reports two to three times daily with an emphasis on daily and same-day scheduled encounters; prioritized working the next day's schedule in advance.
- Maintained patient confidentiality as defined by state, federal, and company regulations.
- Reviewed errors and denials for regionally assigned clinics and properly communicated these issues to the Verification Supervisor.
- Established effective rapport with other employees, professional support service staff, customers, clients, patients, families, and clinicians.
- Utilized EHR systems for note retrieval and data management.
- Actively supported departmental and corporate strategic plans to ensure successful implementation.
