Summary
Overview
Work History
Education
Skills
Timeline
Generic

Carlos Fenney

South Euclid,OH

Summary

Obtain a position as a collaborator in a people-oriented organization and can maximize customer service experiences in a challenging environment to achieve the corporate goals.

Overview

10
10
years of professional experience

Work History

HR Service Center Representative

Cleveland Clinic Foundation
03.2024 - Current
  • Utilized multiple software applications simultaneously for efficient data entry and record-keeping purposes during calls.
  • Reviews caregiver eligibility for FMLA, short-term disability and medical leave. Sends required eligibility and designation notices. Ensures compliance with internal and external policies and regulations.
  • Reviews medical documentation and works with nurse case manager to approve for appropriate benefit pay as well as job protection benefits.
  • Communicates and explains determinations and leave requirements to caregivers.
  • Creates leave cases in HRIS, timekeeping and payroll systems. Schedules payment for caregivers on unpaid and paid leaves of absence.
  • Serves as point of contact for leave inquiries and questions. Advises employees and managers on the organization's leave programs, including maternity or paternity leave, medical or disability leave, military leave, or unpaid leave.
  • Serves as escalation point of contact support to incoming calls/emails/requests from customers (e.g., caregivers, managers, candidates, dependents) to answer questions, resolve issues, and respond to inquiries related to specific area of focus (e.g., Benefits, Absence).

Medical Claims Representative

Progressive
06.2023 - 02.2024
  • Medical claims analysis to make sure we are paying for claims correctly
  • Reviewed medical notes and employer documents to make sure they aligned with the established protocol for reimbursement of wages and other-of-pocket expenses
  • Reviewed medical claims that were paid by health insurance carriers so that we can reimburse correctly
  • Investigation of coverage, fraud, and subrogation issues
  • Claims verification and resolution.
  • Provided excellent customer service to both patients and healthcare providers during the entire claims process.

Claims Processor II

Progressive
02.2022 - 05.2023
  • Separate and processes mail sent in by banks, attorneys, insurance companies and direct customers
  • Indexes non-medical mail and faxes into the appropriate claims so that adjuster can review it
  • Trains new hires on how process and index mail appropriately
  • Reviews new hire work before it goes into the system to make sure it is correct
  • Collaborates with another small group of associates to enhance team building efforts
  • Consistent top performer.

Kidney Transplant Financial Coordinator

Tampa General Hospital
07.2017 - 02.2020
  • Contacted insurance carriers to discuss policies and individual patient benefits
  • Answered questions over phone and in-person regarding billing, scheduling, and treatment
  • Assisted in pre-clearing patients for necessary appointments and procedures required by kidney transplant team
  • Reviewed bills to make sure accounts were paid by correct insurance carrier when it came to transplant services
  • Consistent team top performer
  • Exceeded goals by at least 10% every month.

Kidney Transplant Patient Financial Advocate

Cleveland Clinic Foundation
07.2017 - 02.2020
  • Verified coverage and benefit information for patients
  • Met with donors and recipients during full day evaluation to go over their benefits and to answer questions
  • Assisted in pre-clearing patients for necessary appointments and procedures required by kidney transplant team
  • Reviewed bills to make sure accounts were being paid by correct insurance carrier when it came to transplant services
  • Consistent team top performer
  • Exceeded monthly goals by at least 20%.

Patient Financial Advocate

Cleveland Clinic Foundation
12.2014 - 06.2017
  • Verified coverage and benefit information for patients
  • Obtained payment from self-pay patients
  • Assisted in pre-clearing patients for necessary appointments and procedures
  • Obtained out-of-pocket maximum and deductible amounts prior to scheduling patients
  • Reviewed billing to make sure any package pricing quoted was applied
  • Consistent team top performer
  • Exceeded monthly goals by at least 10%.

Education

Lakeland Community College
Willoughby, OH

Skills

  • Microsoft 365 skills
  • Customer Service Management skills
  • Data entry specialist
  • Scheduling
  • Insurance
  • Training Junior Team Members
  • Financial
  • Benefits
  • Epic experience
  • Complaint Handling

Timeline

HR Service Center Representative

Cleveland Clinic Foundation
03.2024 - Current

Medical Claims Representative

Progressive
06.2023 - 02.2024

Claims Processor II

Progressive
02.2022 - 05.2023

Kidney Transplant Financial Coordinator

Tampa General Hospital
07.2017 - 02.2020

Kidney Transplant Patient Financial Advocate

Cleveland Clinic Foundation
07.2017 - 02.2020

Patient Financial Advocate

Cleveland Clinic Foundation
12.2014 - 06.2017

Lakeland Community College
Carlos Fenney