DENISE MATHIS
Pflugerville
Summary
Analytical Customer Service Professional with 10 years of experience in reviewing documentation, interpreting regulatory requirements, and providing support in healthcare environments. Ensured accuracy in benefits and claims information while maintaining HIPAA confidentiality. Expertise in data entry, records management, and compliance adherence, with a proven ability to resolve escalated customer issues in fast-paced settings.
Overview
13
13
years of professional experience
Work History
Customer Service Representative II
Curative
Austin
07.2024 - Current
- Acted as primary point of contact for providers and members, resolving complex issues while upholding strict HIPAA confidentiality.
- Interpret and communicate member benefit eligibility, referrals, authorizations, and claims information with 100% accuracy in compliance with federal regulatory and quality system standards (21 CFR 820).
- Analyzed provider and member documentation to ensure accurate processing and resolution of inquiries.
- Documented customer interactions thoroughly and accurately in electronic systems to maintain complete record integrity.
- Escalate urgent or non-routine matters appropriately to ensure timely resolution.
- Conduct outreach calls to providers and members for follow-up and issue resolution.
- Coordinate with Medical Management, Pharmacy, Eligibility, and Member Support teams to ensure accurate information processing.
- Provide portal navigation and system support to external stakeholders.
Central Processing Coordinator
Franklin Energy
Port Washington
09.2020 - 07.2024
- Reviewed and processed high-volume documentation for accuracy, completeness, and compliance with established guidelines.
- Monitored and responded to order status inquiries from customers and vendors via email, facilitating timely and accurate communication.
- Identified data discrepancies and corrected records to maintain system integrity and accuracy.
- Processed credit card payments and financial transactions, adhering to internal controls and ensuring compliance with documentation requirements.
- Developed and implemented workflow improvements that increased operational efficiency and reduced manual processing errors.
- Utilized multiple software applications, including Microsoft Word, Excel, and Access, to maintain organized digital records and enhance accessibility.
Customer Service Representative
Austin Regional Clinic (Mediview)
Austin
02.2013 - 09.2020
- Handled escalated calls, identifying resolutions that met customer needs while aligning with organizational policies.
- Cultivated long-term relationships through clear communication and effective problem resolution.
- Provided detailed explanations of medical benefits and claim status to providers and members for Travis County MAP, Medicaid, and Sendero Health Plans.
- Interpreted policy guidelines and eligibility criteria to determine accurate responses to complex benefit inquiries.
- Documented all interactions accurately in electronic systems to ensure traceability and compliance.
- Navigated multiple databases and applications simultaneously to retrieve and verify sensitive information.
- Ensured compliance with company policies, confidentiality standards, and regulatory requirements.
Education
High School Diploma -
North Texas Christian Academy
Fort Worth, Texas04-2006
Skills
- Advanced Customer Service
- Customer service resolution
- Escalation & Complaint Resolution
- Application & Document Review
- Financial Processing & Payment Handling
- Confidential Records Handling
- Regulatory & Policy Interpretation
- Compliance & Quality Assurance
- Workflow Improvement
- Electronic Records & Data Management Systems
- Microsoft Office Suite (Excel, Word, Outlook)
- System Utilization
- Cross-Department Coordination
- Workload prioritization
- Written & Verbal Communication
- Records management
- Records management
Timeline
Customer Service Representative II
Curative
07.2024 - Current
Central Processing Coordinator
Franklin Energy
09.2020 - 07.2024
Customer Service Representative
Austin Regional Clinic (Mediview)
02.2013 - 09.2020
High School Diploma -
North Texas Christian Academy