BOBBIE COLEMAN
Las Vegas,NV
Summary
Motivated customer service professional with 3 years of experience, and a solid foundation in Medicare support, consistently delivering high-quality service and effective solutions. Known for strong collaboration with team members and adaptability to changing needs. Possesses excellent communication skills and proactive approach to problem-solving.
Overview
4
4
years of professional experience
Work History
Medicare Customer Service Representative
Highmark
10.2024 - Current
- Resolve customer concerns via phone and written communication.
- Adhere to HIPAA regulations and Medicare guidelines when handling sensitive patient information.
- Resolved benefit and claim inquiries to ensure the consumers understanding of their coverage options and shared financial responsibility. Ex: Deductibles, coinsurance, out-of-pocket maximums, etc.
- Assist customers with billing issues to ensure successful processing of premium payments and communication of monthly billing information.
- Used CPT codes to verify if prior authorization is necessary within their plan type.
- Used systems such as Microsoft Teams, Outlook, Avaya, Google Chrome, etc. to navigate daily work tasks.
Customer Support, Clinical Care Navigation
Rightway
12.2023 - 05.2024
- Healthcare navigation concierge service delivery via phone, chat, text, and email.
- Source high-quality care providers based on members’ needs and preferences.
- Answer benefit questions, ensure members understand their options and shared financial responsibility, e.g. deductibles, coinsurance, and out-of-pocket maximum.
- Support members with care coordination, such as scheduling doctors' appointments and arranging other ancillary support services.
- Resolve the need for verified provider directories, consisting of calling providers to verify they are in-network and accepting new patients, scheduling member appointments, answering benefit questions, and incoming calls per day from customers.
- Managed approximately 20-50 tickets a day.
Medicare Customer Service Representative
Conduent
07.2023 - 09.2023
- Educated customers about billing, payment processing and support policies and procedures.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Delivered prompt service to prioritize customer needs.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Updated claims system to track claim status and provide relevant information to other departments.
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
Preauthorization Specialist
Continuum Global Solutions
12.2022 - 05.2023
- Handle inbound calls from doctors' offices, and patients to build pre-certifications for medical review.
- Identify if precertification is needed for specific procedures based on CPT codes, and ICD-10 codes provided, verifying accuracy of each code.
- Provide clear and concise information regarding eligibility, precertification status, and requirements to acquire precertification.
- Ensured smooth communication between healthcare providers, patients, and insurance companies, resulting in timely approvals and positive experiences.
- Maintained strict adherence to HIPAA regulations by safeguarding confidential patient information during all aspects of the precertification process.
Commercial Insurance Customer Service Representative
Continuum Global Solutions
01.2022 - 12.2022
- Adherence to HIPAA regulations when handling sensitive patient information regarding the members' claims and benefits.
- Identify issues within medical claims to send back to the proper department for reprocessing.
- Handle member inquiries for grievances, appeals, and prior authorizations.
- Handle inbound and outbound calls to and from doctors' offices, secondary insurance carriers, and customers to resolve billing and benefit inquiries.
- Managed approximately 20-80 incoming calls per day from customers.
- Improved call center performance by consistently maintaining a high level of professionalism and productivity.
- Remote
Medicare Customer Service Representative
Continuum Global Solutions
09.2021 - 01.2022
- Adherence to HIPAA regulations and Medicare guidelines when handling sensitive patient information.
- Identify issues within medical claims to send back to the proper department for reprocessing.
- Handle outbound and inbound calls to and from doctors' offices, secondary insurance carriers, and customers to resolve billing and benefit inquiries.
- Maintained strong working knowledge of Medicare regulations, ensuring accurate information dissemination to clients.
- Provided exceptional support to Medicare beneficiaries, guiding them through coverage options and plan details.
- Handle member inquiries for grievances, appeals, and prior authorizations.
Education
Associate of Science - Medical Billing and Coding
Ultimate Medical Academy
Remote, Clearwater, Florida 06.2021
High School Diploma -
Dr. Phillips High School
Orlando, FL06.2017
Skills
- CPT and HCPCS Level II Codes
- ICD-10-CM and ICD-9-CM Codes
- HCPCS Level II Codes
- CMS 1450
- Medicare, Medicaid, and Commercial Health Insurance
- Medical, Dental, and Vision Insurance Claims & Benefits
- HIPAA Compliance Awareness
- Medical, Dental, and Vision Terminology
- 43 WPM Typing Speed
- HIPAA Compliance Awareness
- Appointment Scheduling
- Active Listening
- Problem Solving
- Time Management
- Data Analysis & Entry
- Strong Oral and Written Communication
- Multitasking
- Adaptability
- Attention to Detail
- Reliability
- Microsoft 365, Word, Excel, and PowerPoint
- AVAYA ONEX
- Slack
- Microsoft Teams
- Outlook
- Salesforce
LANGUAGES
English (U.S.) Native
Awards
Dean's List - Ultimate Medical Academy - 2021, Dean's List - Ultimate Medical Academy - 2020
Timeline
Medicare Customer Service Representative
Highmark
10.2024 - Current
Customer Support, Clinical Care Navigation
Rightway
12.2023 - 05.2024
Medicare Customer Service Representative
Conduent
07.2023 - 09.2023
Preauthorization Specialist
Continuum Global Solutions
12.2022 - 05.2023
Commercial Insurance Customer Service Representative
Continuum Global Solutions
01.2022 - 12.2022
Medicare Customer Service Representative
Continuum Global Solutions
09.2021 - 01.2022
Associate of Science - Medical Billing and Coding
Ultimate Medical Academy
High School Diploma -
Dr. Phillips High School
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