Hi, I’m
Antoinette Phillips
Columbia,SC
Summary
Brings proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs.
Overview
7
years of professional experience
Work History
North Highland
Eligibility Analyst
11.2023 - Current
Job overview
- Served as a knowledgeable resource for junior analysts, providing guidance on difficult cases or complex regulations when needed.
- Maintained organized electronic filing systems for easy retrieval of client records, streamlining daily tasks.
- Implemented new strategies for handling complex cases, resulting in higher success rates for challenging eligibility determinations.
- Demonstrated flexibility by adapting quickly to changes in policies, procedures, or software tools, ensuring seamless service delivery.
Blue Cross Blue Shield
Business Test Analyst II
01.2023 - 12.2023
Job overview
- Coordinates testing and debugging of new or modified software
- Create test matrices, trains, and provides supporting documentation.
- Facilitated knowledge sharing among team members, fostering a collaborative work environment that drove innovation.
- Ensured regulatory compliance through rigorous testing of security protocols and adherence to established guidelines.
- Delivered consistent results under tight deadlines by managing workload effectively and prioritizing tasks based on project needs.
- Contributed to the successful completion of multiple high-profile projects by applying strong analytical skills, attention to detail, and a commitment to excellence.
Blue Cross Blue Shield
Claims Customer Service Advocate II
04.2022 - 01.2023
Job overview
- I adjudicate claims and determine whether to return, deny, or pay claims following organizational policies and procedures.
- Supported team members, fostering a collaborative and productive work environment.
- Assisted in training new employees, sharing best practices for achieving success as a Service Advocate.
- Handled escalations professionally, demonstrating composure under pressure while finding satisfactory solutions for both parties involved.
- Exceeded performance metrics consistently by prioritizing tasks effectively and efficiently.
- Managed high call volumes while maintaining quality service standards and positive customer interactions.
HireRight, LLC
Background Screening Analyst/Customer Service Lead
08.2021 - 04.2022
Job overview
- Handled customer inquiries and suggestions courteously and professionally.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Assisted clients in understanding complex background check results, addressing concerns and answering questions as needed.
- Improved client satisfaction rates by delivering timely and accurate background screening results.
- Verified employment history and educational credentials, providing clients with the necessary information to make informed hiring decisions.
- Continuously updated knowledge on relevant laws and regulations pertaining to background screening practices, ensuring full compliance at all times.
Medshore Ambulance Service
Emergency Medical Technician
02.2021 - 07.2021
Job overview
- Provide first-aid treatment, such as bandaging wounds
- Provide life support care, such as cardiopulmonary resuscitation (CPR), when needed
- Assess a patient's conditions and provide initial treatment
- Determine whether a patient needs to go to an ER or a trauma center
- Work 12-hour shifts, sometimes staying on call for 24 hours
- Communicate with other emergency services, such as firefighters and police officers, to respond to calls for help.
First Citizens Bank
Customer Care Representative
02.2020 - 03.2021
Job overview
- Provide first call resolution for all retail banking inquiries, commercial inquiries, Online Banking (Business and Retail), Bankcard, fraud, forgery, ID theft, and policy and procedure questions.
- Opened, closed, and updated accounts for customers.
- Developed and maintained strong customer relationships, providing exceptional service and advice.
- Maintained strict compliance with all banking regulations, ensuring a secure and trustworthy environment for clients.
Receivable Solutions
Medical Billing Specialist
11.2017 - 06.2020
Job overview
- HCPC and Procedure codes, modifiers, and their effect on reimbursement
- Filing UB04 and HCFA 1500 claim forms
- Resolve insurance denials and file appeals with government and commercial carriers
- Analyze the unpaid claims and denials and investigate the reasons for nonpayment
- Study and contractual terms and conditions of payment
- Make sure certain payments are consistent with the terms
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
Price Waterhouse Coopers (PwC)
Medical Claims Processor
03.2017 - 05.2020
Job overview
- I was responsible for collecting, posting, and managing account payments, I also prepare and submit claims to various insurance companies either electronically in EPIC system or by paper
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Resolved discrepancies between billed amounts and allowed charges promptly by working closely with both providers and payers, minimizing delays in payment processing times.
Education
Virginia CollegeColumbia, SC
from Human Resources Management
07.2020
Argosy University
Psychology- Associates
05.2012
Skills
- Persistent, patient, and sensitive to customer's needs and apprehensions
- Leadership experience including scheduling /coordinating work of peers developing work procedures and training for others
- Data Entry Skills
- Highly skilled in written and verbal communication
- Building Relationships
- Interpersonal Savvy
- Problem Solving
- Multi-tasking
- Ability to provide strong customer service while listening, eliciting information, and comprehending customer issues
- Ability to perform in a fast-paced and high-pressure phone queue environment
- Ability to navigate multiple computer systems, applications, and utilize search tools to find information
- 4 years of experience including in claims and appeals processing
- 4 year of COB processing
- Good spelling, punctuation, and grammar skills
- Ability to handle confidential or sensitive information with discretion
- Medicaid knowledge
- Proficiency in [Microsoft Office Suite]
- Payment Collection
Timeline
Eligibility Analyst
North Highland
11.2023 - Current
Business Test Analyst II
Blue Cross Blue Shield
01.2023 - 12.2023
Claims Customer Service Advocate II
Blue Cross Blue Shield
04.2022 - 01.2023
Background Screening Analyst/Customer Service Lead
HireRight, LLC
08.2021 - 04.2022
Emergency Medical Technician
Medshore Ambulance Service
02.2021 - 07.2021
Customer Care Representative
First Citizens Bank
02.2020 - 03.2021
Medical Billing Specialist
Receivable Solutions
11.2017 - 06.2020
Medical Claims Processor
Price Waterhouse Coopers (PwC)
03.2017 - 05.2020
Virginia College
from Human Resources Management
Argosy University
Psychology- Associates