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Healthplex Dental - Health Exchange Accounting Representative Resume Example

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Isabella Reed
XXX XXXXXXXXX XXXX, Uniondale, NY 11553
XXXXXXXXXXXXXXXXXXXXXXX
Ph: XXXXXXXXXXXX
Summary

I am a responsible professional seeking a position in the Administrative field where I am able to showcase my proven people-oriented skills to develop and promote a positive work environment. My core competencies include excellent communiction and management skills, handling tasks with accurracy and efficiency, goal oriented dedicated to high levels of customer satisfaction and meeting aggressive business goals.  I am passionate and motivated, with a drive for excellence. I am dedicated with two (2) years of experiece combining management and customer service expertise in my varied areas of employment thereby developing positive relationships with customers and staff. I am also extremely analytical with excellent oral and written communication skills, with the ability to work independently with limitd or no supervision and the ability to adapt to new environments and learn new software quickly

Skills
  • Customer and Personal Service
  • Clerical
  • Writing
  • Service Orientation
  • Time Management
  • Microsoft Word
  • Excel, Outlook
  • PowerPoint
  • E-Fax, Image Right
  • Claims Plus
  • E-Case
  • Windows 98, XP
  • QuickBooks
  • Adobe
  • Sir, Juris
  • Cerner
  • Soarian
  • Vantage and Oracle
  • Navision, EVO
Experience
Health Exchange Accounting Representative Aug 2014Present Healthplex Dental Uniondale, NY
  • Confer with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints.
  • Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
  • Review insurance policy terms to determine whether a particular loss is covered by insurance.
  • Check to ensure that appropriate changes were made to resolve customers' problems.
  • Determine charges for services requested, collect deposits or payments, or arrange for billing.
  • Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
  • Refer unresolved customer grievances to designated departments for further investigation.
Pediatric Financial Registrar (Per Diem) Jan 2014Aug 2014 North Shore LIJ Lake Success, NY
  • Entered and updated patient demographics, along with financial information in Soarian computer system, answered multi-line telephone, ake messages, paged and routed telephone calls to the appropriate personnel
  • Verified Medicaid and other forms of medical insurance
  • Provided important patient information to appropriate medical departments/offices and doctors within the facility, where needed
  • Documented, scheduled and confirmed patient appointments
  • Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
Claims Workers Compensation Associate May 2013Dec 2013 Sedgwick CMS Melville, NY
  • Processed general liability claims by gathering information to determine liability exposure, assigned reserve values to claims, made claims payments as necessary, and settling claims up to the designated authority level
  • Processed claims determining compensation and benefits due; monitored reserve accuracy and filed necessary documentation with state agency
  • Processed assigned claims and determines benefits due pursuant to the client contract; makes timely claims payments and adjustments
  • Processed routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims
  • Returned claims to provider/member when information has been omitted from the claim form and made sure claim numbers were properly recorded on all attachments to a claim
  • Maintained departmental productivity and accuracy requirements, reviewed electronic claims and handled claim adjustments Ensured claim files were properly documented and claims coding were correct.
Claims Assistant May 2005Apr 2013 Tower Group Companies Melville, NY
  • Responded to written and telephone inquiries from claimants, doctors, vendors and clients
  • Processed timely payments of claims expenses, medical bills and loss payments
  • Assisted clients, claimants, doctors, medical specialists or employers to obtain additional information on requested claims
  • Prepared new claims first reports, claim investigation bureau reports and create litigation files
  • Opened and labeled mail, recorded priority mail and returned claims sent to Tower in error.
  • Provide customer service, such as limited instructions on proceeding with claims or referrals to various facilities or local contractors.
  • Review insurance policy to determine coverage.
  • Post or attach information to claim file.
  • Transmit claims for payment or further investigation.
  • Contact insured or other involved persons to obtain missing information.
Education
Bachelor of Business Administration: Management Aug 2014 Briarcliffe College Bethpage, NY Management
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Resume Details

This is a real resume for a Health Exchange Accounting Representative in Uniondale, New York with experience working for such companies as Healthplex Dental, North Shore Lij, Sedgwick Cms. This is one of the hundreds of Health Exchange Accounting Representative resumes available on our site for free. Use these resumes as templates to get help creating the best Health Exchange Accounting Representative resume.

Previous Companies:

  • Healthplex Dental
  • North Shore LIJ
  • Sedgwick CMS

Previous Job Positions:

  • Health Exchange Accounting Representative
  • Pediatric Financial Registrar
  • Claims Workers Compensation Associate
  • Claims Assistant

Schools:

  • Briarcliffe College

Level of Education:

  • Bachelor of Business Administration

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