Medical Customer Service Representative Resume Samples

Description :

1. Promptly answers, screens, and processes medical service requests and telephone inquiries with strict adherence to confidentiality agreements and policies and procedures.
2. Provides information on programs, policies, and procedures.
3. Collects and enters patient intake information into the appropriate medical service software system to initiate the transaction.
4. Documents are to be concise, thorough, and accurate.
5. Reviews all patient information and submit payment request.
6. Meets Service standards in all categories on a monthly basis.
7. Meets the expectations of our internal and external customers in providing excellent service.

Experience

10+ Years

Level

Senior

Education

Associates

Description :

1. Contacted referrals and patients to schedule equipment deliveries or to obtain needed medical documentation.
2. Verified various insurance plans and eligibility.
3. Completed the most successful orders within the Austin branch.
4. Failed fax reports.
5. Confirmed orders received from various referrals.
6. Collected and updated demographics and insurance information
7. Verified of health plan eligibility

Experience

10+ Years

Level

Senior

Education

Bachelor's

Description :

1. Effectively instructs and educates families and visitors on logistics of hospital procedures in accordance with policy.
2. Responds appropriately to notifications from electronic systems, including ORMIS Patient Tracker system, OCIS Information Desk Database, Electronic Bed Board and the Daily Census Report.
3. Discusses patient information in accordance with the HIPAA policy.
4. Consistently solicits input and communicates with people from diverse cultures and backgrounds to respond to customer needs.
5. Responds to 90% of phone calls within one working day or in accordance with office standards.
6. Exhibits excellent interpersonal, organizational and management skills.
7. Cross-trains and provides back-up for other customer service representatives when needed.

Experience

2-5 Years

Level

Junior

Education

Associates

Description :

1. Took inbound calls from patients for various reasons, examples being: scheduling appointments, processing payments, verifying insurances, credit checks, signing patients up for our program, as well as answer any questions or handle any concerns they might have.
2. Sent email reminders, and did follow up phone calls regarding appointments and or conflicts they may have.
3. Worked very close with management to the point of raises and various special projects.
4. Helped train new employees when they began working.
5. Ranked among one of the better CSR'S statistically.
6. Taken complete and accurate messages.
7. Scheduled mutually acceptable appointment times utilizing an electronic practice management system.

Experience

2-5 Years

Level

Junior

Education

Bachelor's

Description :

1. Provided quality Bilingual customer service for inbound calls in a timely manner.
2. Responsible for answering any questions members may have about plan.
3. Resolved any member issues with prescriptions, authorizations and etc.in a timely manner.
4. Responsible for a daily log of phone calls per day and primary care physician changes for members.
5. Responsible for ordering over the counter medications for members and assisting them with questions in regards to the medications provided.
6. Provided general information for new members that wanted to join plan and direct them to the correct person for processing.
7. Assisted providers with any billing or claim questions, or general information about a certain plans.

Experience

5-7 Years

Level

Executive

Education

Bachelor's

Description :

1. Answered incoming calls within a call center, provided information on behalf of medical worker's compensation clients and providers.
2. Received requests by mail, telephone regarding claim status.
3. Identified coding and billing problems from EOBs and worked to correct the errors.
4. Provided administrative support to the Clinical Review department if needed.
5. Explained reconsideration procedures.
6. Mailed or route claim forms and supporting documentation to various units for final processing.
7. Responded to inquiries grievances, complaints or appeals.

Experience

7-10 Years

Level

Management

Education

Bachelor's

Description :

1. Communicated with pharmacies or medical offices through inbound and outbound calls and written communications Responding to customer questions and helping to resolve their problems Using the computer system to track, gather information and/or trouble-shoot issues for customers.
2. Provided exceptional customer service when interacting with customers, medical professionals and their office staff.
3. Documented and updated records in the required systems while following company and client requirements.
4. Remained calm and helpful even when dealing with upset customers.
5. Escalated customer complaints and/or calls to your manager when necessary.
6. Provided feedback and recommendations to manager on ways the company can improve.
7. Performed other duties as assigned by management team.

Experience

2-5 Years

Level

Junior

Education

Associates

Description :

1. Performed various duties that required multi-tasking skills in a fast paced environment.
2. Coordinated with internal departments and external resources (multiple data sites) to address inquiries by members and providers.
3. Reviewed processed claims to identify payment information, denial reasons, claim errors, etc.
4. Educated and consulted members and providers about Medicare and Quest medical plan benefits.
5. Utilized Encoder coding software and CPT, ICD-9-CM, & HCPCS coding manuals to identify coding errors Manage day to day operations by utilizing various computer software applications, MS Word, Excel, Power Point, Outlook, QNXT medical database platform, and Contact Client call management software.
6. Promptly answered patients' billing and medical questions with strict adherence to confidentiality agreements, HIPAA, and policies and procedures.
7. Followed work flow processes via the EPIC computer system in order to get a claim processed and paid, resolve customer complaints, and to log billing discrepancies.
8. Supported the management team in identifying operational opportunities for continuous improvement and initiating changes to center processes as needed through use of company approved procedures.

Experience

5-7 Years

Level

Executive

Education

Associate's

Description :

1. Reviews internal databases to complete accurate and timely follow-up on pending and inactive claims.
2. Contacts the insured, insured's representative or provider to follow-up on information needed to process the benefit inquiry.
3. Keeps clear and concise documentation of all claim activity within the internal databases.
4. Meets quality and production metrics as established and communicated by the department.
5. Processes requests from the client or from other departmental areas within LTCG.
6. Answers calls from policyholders, members, agents, providers, hospitals regarding benefits or other issues.
7. Answers claim benefit questions from callers on both group and individual products.
8. Provides solutions to problems, confirm eligibility, and/or plan coverage.

Experience

10+ Years

Level

Senior

Education

Administration

Description :

1. Provided customer service to our members.
2. Helped customers find the correct plan for their needs.
3. Solved issues the customer may have had with their billing issues.
4. Explained their benefits and how they worked.
5. Found doctors near by for the members.
6. Assisted in helping members with the health exchange.
7. Processed 90 patient requests by telephone daily regarding health insurance.
8. Provided counsel and guidance to clients for benefit plans, adjustments and claim status.
9. Researched and interpreted policy and provisions.

Experience

0-2 Years

Level

Entry Level

Education

Bachelor's