Provider Service Representative Resume
Objective : To work for a company, agency, or organization where could apply knowledge and skill, as well acquire new ones and contribute to its existing mission.
Skills : Excellent communication including reading and writing in English and Spanish Basic computer Word.
- Identified and resolved provider issues by researching causes and working with Beacon's clinical, operations and IT teams.
- Assisted in the identification of service level gaps and works with Manager of Provider Relations and Contract Managers to address recruitment opportunities.
- Actively outreached and trained providers to increase the rate of electronic transactions through training and education.
- Worked with Manager of Provider Relations to plan and present provider events, including Provider Advisory Councils and Provider Appreciation Breakfasts in all markets.
- Processed improvements for Operations, Logistics, and Contract Administration organizations.
- Analyzed and processed program managed facets of the business ultimately creating and improving our overall operations, logistics and contract administration organization.
- Analyzed workforce and found internal candidates rather than hiring temporary employment.
Sr. Provider Service Representative Resume
Summary : To benefit your office and/or company by performing and enhancing the clerical, medical, and data entry skills Already obtained. At the same time, further career with the many years of experience obtained in the medical field. Offer a lot of knowledge, experience, and common sense to your medical practice.
Skills : Ability to communicate effectivly, Excelent customer service, Intermediate computer using word, excel, powerpoint, and photoshop.
- Maintained an up to date knowledge of AvMed's product offering and plan guidelines.
- Used negotiating skills when dealing with complex issues or irate customers.
- Answered high volume multi-line telephone for Provider Service Center Call Center.
- Responsible for providing claim status.
- Achieved paper status on a daily basis.
- Provided in a timely manner through fax or by mail, explanation of payments to providers.
- Provided research and resolution to provider issues.
Certificate In Nursing Assistant
Jr. Provider Service Representative Resume
Objective : To secure a position within an established organization that values customer service skills and offers opportunities for professional development.
Skills : Medical Billing,Medical Administration,Clerical,Office.
- Handled an influx of calls, answering questions and resolving clients queries Collaborated with medical/dental providers providing general answers in regards to clients health insurance benefits and claims Data entry, navigated through various screens and software programs to accomplish many tasks.
- Collected and distributed inter-office correspondence, provided clerical and administration training, and all aspects of the administration.
- Utilized WebMD, EPDB, TOLR, ECHS, and Rumba Mainframe Accomplishments I actively contributed day to day giving out accurate information to our customers.
- Used Attention to detail,accuracy, and efficiency.
- Worked under constant pressure and deadlines, administrative and clerical.
- Used various computer software.
- Assisted with issues regarding Cancelled Checks, Direct Deposit, Provider Data Changes, Explanation of Payments, Overpayments, and Web Issues.
Diploma In Medical Billing
Provider Service Representative III Resume
Objective : To secure a position that will enable me to utilize experience and skills to benefit an organization, Analyzed and resolved customers' issues referring unresolved grievances to designated departments for further investigation. Adhered to industry standard call center performance measures, abiding by HIPAA guidelines and regulations.
Skills : Type 60 Wpm, Data Entry, Public Speaking, Bilingual Spanish, Customer Service, Team Player, Microsoft Office.
- Documented all activities for reporting and resolution; Answer inquiries from providers regarding claim, eligibility, covered benefits, authorization status issues.
- Provided first call resolution through issue documentation and resolution with appropriate internal resource, and follow-up and ensure closure with the contact who initiated the inquiry.
- Responded appropriately to provider issues and concerns, and provide trending feedback to improve the customer experience.
- Processed customer correspondence and provide the appropriate level of timely follow up.
- Managed service related follow up items and outstanding tasks in accordance with established turnaround times.
- Provided assistance to provider regarding website registration, navigation and customer related inquires.
- Educated providers on health plan initiatives during interactions with providers via telephone.
Provider Service Representative II Resume
Headline : To obtain a Healthcare position that will allow to use knowledge of Healthcare to members and patients in a professional support service manner.
Skills : Customer Service , Health Care.
- Provides all clerical support for the Review.
- Assists callers on the Beneficiary Helpline.
- Responsible for the typing/merging, proofing for clarity, printing and mailing correspondence.
- Assists with participate in Review Team in identifying areas for potential improvement as noted on case reviews and process.
- Performs other duties as assigned by Review Support Supervisor.
- Works on multiple Medicare and Medicaid contracts for prior authorizations.
- Educates providers by instructing and advising of the comprehensive policies and procedures involving all phases of the benefits and contracts .
Provider Service Representative I Resume
Summary : Administrative Assistant with over 13 years of responsible corporate experience with a proven record of accomplishment in the areas of customer relations, scheduling, staff supervision, and general office operations seeks a full time position where I can utilize my strong organizational abilities combined with excellent interpersonal, communication, and leadership skills that allow me to work effectively with other people at all levels.
Skills : Microsoft, Cashier.
- Identified and implemented specialty care outreach clinics around the south central region of Wisconsin.
- Completed face-to-face sales meetings with physicians, appointment schedulers, clinic managers, and medical staff from referring hospitals and independent medical groups.
- Coached physicians on how to achieve a successful patient relationship.
- Worked on committees with hospital leadership to develop regional strategic business plans.
- Developed strategic sales initiatives to increase downstream revenue from rural areas around the region.
- Strategically planned emergency and surgical services initiatives between physicians and hospital leadership throughout the region to bring awareness of Meriter's quality outcomes and services focusing on best practices for best patient outcomes and experience.
- Developed new specialty care clinics in and around south central Wisconsin.
Assistant Provider Service Representative Resume
Objective : Dedicated health plan professional seeking a position that is rewarding and challenging within the Healthcare sector where prior experience, personal ability and a commitment to professionalism would be of value.
Skills : Computers, Internet, Detail Oriented, Multi-tasking, Communication.
- Responsible for building and maintaining relationships between Lovelace Health Plan and contracted providers and contracted facilities.
- Created presentation documents for annual Provider Orientation meetings, verified all documents complied with CMS and HSD requirements.
- Managed the entire process for hosting, coordinating and increasing attendance to annual provider orientation meetings.
- Responsible for presenting on updates and changes within the Lovelace Health Plan, speaking about all several departments and topics within the health plan.
- Answered provider questions as to whether claims were processing per negotiated rates, researched and resolved provider specific claims issues.
- Responsible for Southwestern NM, El Paso, Alamogordo, Bernalillo and Valencia Counties, combined territories contained over 2000 providers, eight hospitals and three IPAs.
- Updated and maintained provider rosters, performed credentialing site reviews for prescribing behavioral health providers as well as primary care offices.
- Maintained phone log tracking and documenting all incoming and outgoing calls.
Bachelor Of Arts
Associate Provider Service Representative Resume
Headline : Employed as a provider service representative for SummaCare Insurance Company. Here at SummaCare in customer service for a Florida Medicaid MMA program, First Coast Advantage. Here answer phone calls from members and providers in regards to eligibility, claims and claims resolution, benefits, authorizations, as well as grievance and appeals.
Skills : Type 60 wpm, Filing, Data Entry, Telephone Usage, Organizing.
- Assisted providers with paid and/or denied claims Advise providers on members specific benefits Advise provider if they did or did not need authorization was also trained to speak with members when there was call overflow Accomplishments was given Mentor status within 5 months of hire.
- Able to assist other agents on the phone with any questions or concerns they might have.
- Able to take supervisor requested calls for those agents.
- Received Agent of the Month twice during year of employment.
- Used have computer skills in multiple different computer programs.
- Trained new staff to ensure successful customer service with a 98% retention rate.
- Maintained performance and quality standards based on established call experience guidelines.
Provider Service Representative/Manager Resume
Summary : Seeking a position where customer service and administrative skills can contribute to a company. Provider Service Representative is responsible for providing value to the provider through customer service, and is also responsible for ensuring compliance with the provider’s policies and procedures.
Skills : Graphic Design, Customer Service, Insurance, Healthcare.
- Handled provider inquiries regarding medical benefits, prior authorization s and claims processing.
- Explained claims adjustments.
- Researched claims identifying and resolving issues and provide appropriate timeframes for reconsideration follow-up request.
- Determined clinical requirements.
- Researched authorization request and resolve issues when deemed necessary.
- Verified provider contract information and fee schedule.
- Refered provider to reimbursement policies as it relates to the claim in question.
- Focued on proficiency and accurate information.
Bachelors Of Arts
Provider Service Representative Resume
Summary : Seeking a full time junior level position where my skills and experience can be effectively utilized for increased profitability. Developed an invaluable skill set that will allow to be an effective and contributing asset to the company's growth and integrity. An opportunity to be interviewed at this establishment as well as any time taken to review resume is greatly appreciated.
Skills : Graphic Design, Customer Service, Insurance, Healthcare.
- Responded to member questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
- Developed and maintained positive member relations and coordinating with various functions within the company to ensure member requests and questions are handled appropriately and in a timely manner.
- Researched and analyzed data to address operational challenges and member service issues.
- Provided external and internal customers with requested information.
- Received and placed follow-up telephone calls / e-mails to answer member questions.
- Assisted providers with status on claims , eligibility of members , Vision authorization and editing of authorization.
- Took up to 70 calls a day assisting providers with their daly needs.