Customer Service Rep
Resume:
Ursula Douglas
Patient Advocate/Customer Service Rep
Fort Mill, SC 29715
*********@*****.***
Authorized to work in the US for any employer
Work Experience
Intake Coordinator
Brighton Health Plan Solutions-Garden City, NY
November 2022 to November 2024
• Inbound calls for pre authorization requests
• Gathered patient information and provider’s information to send for review for services being rendered.
• Routed pre authorization to correct queue
• Documented accounts with information gathered from providers/members
• Escalated urgent review for potential life threatening events.
• Uploaded incoming fax requests for pre authorization to patient’s account.
• Followed HIPAA guidelines
PATIENT SERVICES REPRESENTATIVE
THE LASH GROUP-Fort Mill, SC
July 2019 to August 2022
• Answer basic and clinical inquiries from callers.
• Facilitates access to appropriate support services, including reimbursement counseling, nursing hotline and support.
• Process incoming enrollment forms for program.
• Follows up via phone, mail, and/or fax for missing enrollment information.
• Supports payer research, health care policy library, and state management.
• Make suggestions and recommendations to manager in an effort to continually improve service operations.
• Ensure that related information is obtained, documented in detail, tracked and available for access and quality review.
• Develop and maintain close interface with all components of the benefits process.
• Identifies other sources of health care for patients through simple queries and use of Fusion database. COMPLIANCE LIAISON
BURKERT FLUID CONTROL SYSTEMS-Remote
November 2015 to April 2018
• Responsible for corresponding with vendors in order to secure compliance documents
• Ensured due diligence within the supply chain as set both by both the European Union and the Dodd Frank Act
• Investigated the disposal of electrical and electronic waste
• Verified the 3TG's (Tin, Tantalum, Tungsten, and Gold) were registered, evaluated, and authorized BILLING COLLECTION SPECIALIST
RIVERVIEW MEDICAL CENTER-Rock Hill, SC
August 2012 to March 2013
• Worked all Medicare correspondence
• Resubmitted corrected claims and supplied medical necessity letters for appeals. Assisted with commercial insurance follow up
• Reviewed, prepared, and submitted patient invoices
• Contacted guarantors via phone regarding outstanding balances PATIENT ACCOUNT REPRESENTATIVE III
NOVANT HEALTHCARE CBO-Charlotte, NC
February 2009 to July 2012
• Interacted with Commercial, Managed Care, Medicare/Medicaid and/ or guarantors to expedite claims resolutions
• Examined claims denials from payers by investigating and correcting errors for resubmission
• Communicated with coders regarding CPT/ICD codes, modifiers, and medically necessary services
• Reviewed daily reports for aging claims and aggressively pursued resolutions
• Communicated with provider relations regarding credentialing issues for physicians ADMITTING/INSURANCE SPECIALIST
PIEDMONT MEDICAL CENTER-Rock Hill, SC
June 2000 to August 2007
• Collected payments such as copays, deductibles, and coinsurance prior to outpatient surgery
• Verified eligibility and benefits via internet and telephone
• Monitored daily reports for demographic errors
• Followed up with insurance carriers for reimbursement status
• Directed patient flow during practice hours to minimize patient wait time
• Completed patient registration by having patients sign all necessary paperwork and answered any questions or concerns.
• Diligently explained the HIPAA policy
Education
Some College in Healthcare Management
CAPELLA UNIVERSITY - Minneapolis, MN
October 2008 to May 2010
Some College in ACCOUNTING
USC-Lancaster - Lancaster, SC
August 1988 to April 1990
Diploma
GREAT FALLS HIGH SCHOOL - Great Falls, SC
August 1984 to June 1987
Skills
• ORGANIZATIONAL SKILLS
• EFFECTIVE COMMUNICATOR
• TEAM PLAYER
• 10 KEY PROFICIENT
• WORK WELL WITHOUT SUPERVISION
• SELF MOTIVATED
• VERY CONSCIENTIOUS OF BOTH HIGH DOLLAR AND AGING CLAIMS DUE TO TIMELY FILING GUIDELINES
• STRONG PROFESSIONAL WORK ETHIC AND ATTITUDE
• Medical Collection
• Managed Care
• Insurance Verification
• Medical Billing
• Medical Records
• ICD-9
• ICD-10
• EMR Systems
• Medical Office Experience
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