A Provider Phone Representative helps customers with complaints and questions, provides customers information about products and services, takes orders, and processes return. A well-drafted Provider Phone Representative Resume mentions the following duties and responsibilities – maintaining a positive and professional attitude towards customers, responding promptly to customer inquiries, communicating with customers through various channels, knowing our products inside and out, processing orders, forms, and applications; processing orders, and requests; keeping records of customer interactions, and comments; providing feedback on the efficiency of the customer service process, and ensuring customer satisfaction and providing professional customer support.
To do well in this role, job applicants should possess the following skills and abilities – the ability to stay calm when customers are stressed or upset, comfortable using computers, experience working with customer support. A high school diploma or GED is commonplace among job applicants.
Objective : Highly qualified Provider Phone Representative with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and I would excel in the collaborative environment on which your company prides itself.
Skills : Microsoft Powerpoint, Training Skills.
Description :
Provided benefits, reading claims, researching CPT, HCPCS, and ICD codes.
Completed several trainings, which include benefits, claims, coding, and intake.
Received several 100% surveys from providers for great customer service.
Used Microsoft office, UNET, Knowledge, TOPS, internal software, and the internet are the systems I use daily.
Provided exceptional customer service to clients Process insurance claims for Physicians based upon rendered services Address questions, concerns.
Assisted with training new hire employees.
Assisted supervisors with escalated issues and callbacks.
Experience
2-5 Years
Level
Executive
Education
Associates In Business Administration
Provider Phone Representative Resume
Objective : To obtain a Provider Phone Representative position in a company while utilizing my excellent skills and capabilities from my seven years of military experience and previous job positions.
Skills : Microsoft Word, Microsoft Outlook, LCD-9 Coding, Hipaa, HCPCS, Billing.
Description :
Answered provider phone calls in a timely manner.
De-escalated any provider issues using soft people skills.
Assisted teammates when questions arise.
Continued to become knowledgeable in numerous computer systems and uses systems while assisting the provider.
Provided first call resolution to limit call backs.
Helped maintain the site and teams goals.
Consistently met monthly goals by providing accurate information.
Experience
2-5 Years
Level
Junior
Education
High School Diploma
Provider Phone Representative Resume
Objective : Provider Phone Representative is responsible for all aspects of the sales process in the healthcare industry. Constantly monitoring competitors' products and pricing strategies to ensure best practices are used in the industry.
Skills : Word, Excel, Powerpoint, Visio, Project Management.
Description :
Received exemplary scores.
Provided claim details such as but not limited to claim payments, denial and coordination of benefits.
Created labels electronically and mails out recorded documents.
Prepared documents, including plat maps, for processing.
Executed the microfilming and optical scanning of documents.
Performed data entry of grantor and grantee information as needed.
Coordinated with doctors and physicians to retrieve lab orders.
Experience
2-5 Years
Level
Junior
Education
High School Diploma
Provider Phone Representative Resume
Objective : As a Provider Phone Representative, responsible for Answering member calls regarding balance inquiries, withdrawals, transfer requests, debit card transactions, etc, Assisting members with a certificate of deposit requests, rate information, maturity options, etc.
Skills : General Office, Records Clerk, Data Entry, 10-key, Microsoft Office, Internet Proficient, Type 45 WPM, Switchboard, Call Canter.
Description :
Assisted in checking patient records, in accordance with HIPAA regulations, for medical & dental coverage.
Provided information about products and services.
Resolved customer issues.
Transferred customers to appropriate departments as needed.
Answered general questions about the company.
Maintained a high level of product knowledge across all our programs.
Reached out to providers proactively to ensure they are aware of program updates and changes.
Experience
2-5 Years
Level
Junior
Education
GED
Provider Phone Representative Resume
Objective : Seeking a Provider Phone Representative position in a challenging professional environment that will allow me to further extend my professional background in Medical Billing, Claims, and Patient Access Services as well as offer opportunities for growth and advancement.
Skills : Human Resources, Retail Management, Inventory, Interviewing, Hiring, Organized.
Description :
Resolved customer service inquiries which included; Benefit and Eligibility information, Billing and Payment issues, Physician assignments, and Explanation of Benefits (EOB).
Provided excellent customer service Constantly meet established productivity, schedule adherence, and quality standards.
Accurately documented, researched, and resolved customer service issues.
Managed customer calls effectively and efficiently in a complex, fast-paced, and challenging call center environment.
Referred unresolved customer grievances to designated departments for further investigation.
Served as Subject Matter Expert in new hire classes.
Responded to, troubleshoot, and resolved patient issues in a timely and positive manner.
Experience
2-5 Years
Level
Executive
Education
MS
Provider Phone Representative Resume
Summary : Successful experience with customer satisfaction and high volume inbound call center operations for major companies including Kaiser Permanente, United Healthcare, and Verizon Wireless. Successful experience supervising juvenile offenders in a Level Five secure detention facility. Previous experience as a Lead Staff.
Skills : Microsoft Word And Excel, Managing Skills.
Description :
Responded to incoming calls from United Healthcare medical Providers.
Informed the Provider of Plan features regarding Medicare Replacement Health Plans.
Gave details regarding member benefits including copayments and out-of-pocket maximums.
Reviewed Hospital and Physician Claim status with medical Providers and relaid payment information.
Explained claim denials and give the provider options on how to resubmit for payment.
Accepted incoming calls from individual medical providers, medical practice facilities, hospitals, and medical specialist offices to identify their areas of need and assistance.
Assisted with the manual and automated processing of medical claims for ensuring accuracy for reimbursement.
Experience
7-10 Years
Level
Management
Education
Bachelor Of Arts
Provider Phone Representative Resume
Headline : Advanced knowledge and proficiency in Microsoft Office (Word, Excel, Access, Outlook, and PowerPoint) Efficient in AS/400, SAP, CMS1500, CPT/HCPCS, EMR/ERH systems Certified Pharmacy Technician by the State of Missouri Personal Skills Advanced knowledge in Inventory Management, Customer Service, Sales, Scheduling Possess strong communication, exceptional proven customer service, and organizational skills Self-starter with a can-do attitude.
Skills : Advanced Knowledge And Proficiency In Microsoft Office, Efficient In AS/400, SAP, CMS1500, CPT/HCPCS, EMR/ERH Systems.
Description :
Provided awesome customer service to healthcare providers in regards to verifying benefits, explained or resolved issues on how a medical claim was processed and gave providers' network status.
Data entry and maintaining spreadsheets.
Selected to work on special projects and to be the spokesperson for unit meetings.
Exceeded all departmental goals and earned the maximum on bonuses.
Answered inbound calls from medical providers needing information in regards to patients' medical benefits and medical claims that were filed.
Gave information about co-insurance, copays, deductibles, in and out of network benefits, and any specific limitations related to CPT/HCPC codes provided.
Researched claims for providers to give accurate information on how a claim was paid, or why it was not.
Experience
5-7 Years
Level
Executive
Education
Bachelor Of Arts
Provider Phone Representative Resume
Objective : Self-starter Mortgage professional with skills in compliance regulatory affairs, underwriting, and mortgage repurchase one of my core objectives is to reduce company risk while managing business relationships. Customer service representative with strong organizational skills while effectively handling multiple tasks simultaneously demonstrates the ability to acquire and apply knowledge rapidly while meeting or exceeding departmental goals.
Skills : Fast Learner, Creative Problem Solving, Meditech, Medical Terminology, Pharmacology, Insurance Verification, Workers Compensation, Computer Literate, Customer Service.
Description :
Facilitated new hire participant training in the position of Provider Phone Representative (PPR), as well as tenured employees in various up-training curricula.
Experienced in teaching adult learners using one-on-one coaching, monitoring call quality, and analyzing metrics.
Assisted providers with submitting reconsiderations for claims and with the appeals process.
Identified areas of uncertainty and discrepancy with medical claim processing, and ensured proper understanding of the processing of medical claims for proper understanding.
Provided complete and accurate coverage of benefits with the explanation and clarification of individual's benefits covered through their specific commercial employer group plans.
Coordinated with our local city teams assisted mobile specialists and provide ongoing updates to patients.
Experienced processing or reading lab orders.
Experience
2-5 Years
Level
Executive
Education
GED
Provider Phone Representative Resume
Headline : A self-motivated, hard-working employee with six years of office management and supervisory experience seeking career advancement. Organized Hard-Working Independent Skilled in Microsoft Office Fast Typing (80+ WPM).
Skills : Microsoft Office, Tempworks, Customer Service.
Description :
Handled all incoming calls, inquiries, or concerns in a positive and helpful manner, seeking resolution and follow-up within 24 hours.
Resolved physician and/or office staff, member, and/or health plan inquiries or concerns within 24 hours, documenting the solution.
Performed timely research and uses appropriate resources (i.e., UM for referrals, contract verbiage, etc.) in problem-solving to achieve a satisfactory disposition.
Prepared documentation necessary for adjustments
Documented AZPCs claims adjudication system with permanent information to track the claim inquiry.
Maintained knowledge of all Health Plan DOFRs (Division Of Financial Responsibility) administered by AZPC claims department including but not limited to HMO, PPO, Private, and Medicare.
Verified insurance benefits and co-pays as needed.
Experience
5-7 Years
Level
Executive
Education
High School Diploma
Provider Phone Representative Resume
Objective : Phone Representative is a customer service representative who handles inbound customer calls and chats to provide information and help to customers, as well as to determine the nature of the call.
Skills : Microsoft Word, Lotus/Lotus Notes, Subject Matter Expert, Root Cause Analysis, Project Management, Effective Presentation, Team Facilitation, KANBAN, Process Improvement, And Adult Training.
Description :
Worked with Eligibility and Benefits departments on an as-needed basis.
Assisted the Member Services department with claims adjudication as needed.
Educated the caller(s) as to the correct processes as needed.
Assisted the public at the Public Assistant Counter, offsite Kiosk, or via telephone.
Determined and collected recording and copy fees, makes the correct change, balanced receipts, and balances the cash drawer.
Opened and recorded documents received by mail for recordation; accepted documents received via digital submission from companies.
Assigned recording numbers and ensures compliance with current recording standards and statutes.
Creating an account is free and takes five seconds.
You'll get access to the PDF version of this resume template.
Choose an option.
Sign up with Google
Sign up with Facebook
Sign up with Linkedin
This helps us make sure you're human and prevents spammers from abusing our services.
By continuing, you agree to our Privacy Policy and Terms.
Unlock the Power of Over 10,000 Resume Samples.
Take your job search to the next level with our extensive collection of 10,000+ resume samples. Find inspiration for your own resume and gain a competitive edge in your job search.
Get Hired Faster with Resume Assistant.
Make your resume shine with our Resume Assistant. You'll receive a real-time score as you edit, helping you to optimize your skills, experience, and achievements for the role you want.
Get Noticed with Resume Templates that Beat the ATS.
Get past the resume screeners with ease using our optimized templates. Our professional designs are tailored to beat the ATS and help you land your dream job.
