Customer Service Follow Up
Resume:
Brian Morsch
Claims Follow Up Specialist at Ensemble Health partners
Cincinnati, OH 45238
ad8fz1@r.postjobfree.com
Highly organized and self motivated as well as team oriented, strong work ethic, able to multitask and eager to learn something new. Have many years of customer service and claims experience. Authorized to work in the US for any employer
Work Experience
Claims Follow Up Specialist
Ensemble Health Partners - Blue Ash, OH
March 2018 to Present
Follow up with different insurance companies regarding medical claims. We make phone calls or send correspondence to get claim paid
• Fulfilling medical records
• Obtaining Prior Authorizations
• Monitoring All fax logs
• Verify all insurance information
• Complete medical forms in accordance with company policy
• Review work done by others to make sure no errors were made
• Run team meetings each week and give any updates or policy changes . Team Lead Claims Analyst
Tri-Health - Cincinnati, OH
June 2014 to February 2018
• Investigates member/provider complaints or appeals as they relate to benefit interpretation or claims payment.
• Completes appropriate documentation/system remarks and communicates with all parties to ensure timely resolution and customer satisfaction.
• Assists Claims Manager in monitoring payable and pended claims through weekly reports to ensure accuracy and compliance with contract requirements, identifies system and/or processing errors and assists in resolution.
• Completes comprehensive documentation/system remarks to provide an audit trail for reviewers of complex claims issues.
• Coordinates the resolution of pended claims by requesting information from physicians, hospital and personnel, third party payors and health plan representatives as needed to determine benefits and liability.
• Provides technical assistance and/or system training to improve quality and production.
• Demonstrates proficiency in processing routine and complex medical claims involving all coverage types by maintaining accuracy with routine quality review and checks.
• Analyze reports and take appropriate action based on the information or data on report
• Supervised call center reps
• Processed refund checks
Claims Correspondence Front Line Leader
Humana - Cincinnati, OH
March 2005 to June 2014
• Answered incoming correspondence.
• Processed COB claims, DME, Physician claims, Hospital claims, Home Infusion, Review of Physician
• and hospital contracts.
• Coached team on quality results.
• Led team meetings.
• Trained new employees.
• Led interviews for potential new hires.
• Responsible for sending outgoing letters to physicians and members.
• Making outbound calls regarding the claims in question.
• Monitor assignments to make sure service levels are met Education
High school diploma
Finneytown High School - Cincinnati, OH
1993
Skills
• Claims (10+ years)
• Customer Service (10+ years)
• medical claims (10+ years)
• RECEPTIONIST (3 years)
• RETAIL SALES (5 years)
• Medical Records
• ICD-10 (9 years)
• ICD-9
• CPT Coding
• Medical Coding
• EMR Systems
• Insurance Verification
• Medical Billing
• Medical Terminology (10+ years)
• ICD coding
• Medical office experience
• Epic
• Auditing
• Customer service
• Delivery driver experience
• Moving
• Sales
• Time management
• Customer relationship management
• English
• Phone etiquette
Certifications and Licenses
Driver's License
Additional Information
Skills
CLAIMS (10+ years), CUSTOMER SERVICE (10+ years), RECEPTIONIST (5 years), RETAIL SALES
(5years), MEDICAL CLAIMS (10+ years)
Computer Skills
Able to type 30-40 words a minute
Knowledge of Microsoft Word, Excel, and other various programs Knowledge of CPT and ICD-9 and ICD-10 and HCPC codes and Healthcare plans Excellent retail and customer service experience as well as knowledge of medical claims Able to multitask and work well with others
Excellent interpersonal and communication skills
Contact this candidate