April Jones
Paris,TX
Summary
Results-driven professional focused on delivering exceptional support for customer needs. Successfully manages concerns and resolves conflicts to maximize customer satisfaction. Offers strong background in customer relations and communication.
Overview
6
6
years of professional experience
Work History
Member Service Representative
Medix Staffing
Remote, TX
11.2021 - Current
- Helped providers and members every day with positive attitude and focus on satisfaction.
- Assisted members with quality service by providing information regarding their plan, benefits, and eligibility.
- Assisted providers with claims and prior authorization status.
- Effectively communicated with members and providers about changes to Medicaid processes.
Member Service Representative
Molina Healthcare
Irving, TX
01.2017 - 12.2018
- Provided excellent customer service to Medicaid members.
- Assisted members with benefits, eligibility, finding primary doctors, scheduling appointments, and transportation.
- Learned internal systems and related service role duties to provide skilled team backup in handling customer demands.
- Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions.
Patient Care Assistant
Newmetric Home Healthcare
Dallas, TX
12.2014 - 12.2016
- Attended to patient and family's immediate needs and concerns by acknowledging and providing required attention.
- Monitored and maintained cleanliness, sanitation, and organization of assigned station and service areas.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
- Completed documentation of care, hospital actions and patient activities.
Claims Validator
Christus Health
Irving, TX
01.2013 - 03.2014
- Validation of payment in full
- Changing the financial obligation to the next payer if applicable.
- Initial follow up with the payer for zero payments, overpayments, underpayments, and appeals.
- Initiate refunds/recoupment on overpayments to the payers.
- Verified payments received were in accordance to the contractual agreement to reflect the correct balance and status of patients.
Education
Some College (No Degree) - Medical Records Coding
Paris Junior College
Paris, TXGED -
Paris Junior College
Paris, TX08.2019
Skills
- Issue and Complaint Resolution
- Customer Service
- Phone Etiquette
- HIPAA
- Windows
- Medical Collections
- ICD-10
- Microsoft Excel
- Medical Terminology
- ICD coding
- Typing
- Medical Records
Timeline
Member Service Representative
Medix Staffing
11.2021 - Current
Member Service Representative
Molina Healthcare
01.2017 - 12.2018
Patient Care Assistant
Newmetric Home Healthcare
12.2014 - 12.2016
Claims Validator
Christus Health
01.2013 - 03.2014
Some College (No Degree) - Medical Records Coding
Paris Junior College
GED -
Paris Junior College
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