Gena Searcy
Rockford,IL
Summary
Achieved streamlined customer service and insurance claims processing, enhancing operational efficiency in demanding environments. Trained and guided staff to deliver outstanding service, fostering positive member and provider experiences. Elevated service quality and operational effectiveness by leveraging in-depth knowledge of Medicare and Medicaid systems.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Inbound Contacts Representative 2 (full Time)
Humana
Milwaukee, WI
07.2024 - Current
- Oversees claims training for new hires and provide remedial training as needed.
- Deliver comprehensive benefit and claims information for Medicare and Medicaid to members and providers confirming HIPAA and maintaining federal regulations.
- Facilitate provider claim status inquiries, clarifying denials and payment processes and authorizations.
- Supported members in submitting grievances to uphold organizational standards and member rights.
- Applied knowledge of QNXT, TruCare, Macess, and CMS guidelines to ensure compliance and operational efficiency.
Inbound Contact Service Representative 1
Humana
WI
11.2022 - 07.2023
- Assisted members and providers with inquiries regarding eligibility, claims, and benefits in a fast paced call center taking over 40 calls a day.
- Investigated claim statuses, including denial reasons and payment explanations.
- Facilitated the escalation of member complaints, appeals, and grievances.
- Checked the status of authorizations and referrals.
- Proficient in QNXT, Trucare, and Macess.
- Resolved customer inquiries and concerns, ensuring high satisfaction levels through effective communication.
- Educated clients on product features and benefits, enhancing user experience and retention rates.
Insurance Reimbursement Specialist
CareMetx, LLC-Bethesda
MD
12.2021 - 02.2022
- Initiated outbound calls to payers in order to gain missing data needed to finalize medical benefit investigations.
- Confirmed and analyzed data received and then enter data into internal portal.
- Completed daily reporting for performance and measurement of successes.
Sales Fulfillment Coordinator
Taylor Company
Rockton, IL
04.2017 - 08.2020
- Used software to enter, track, check, and route orders.
- Directed the flow of packages from preparation to shipment.
- Managed all important documents such as bill of ladings, custom declarations and proforma invoices.
- Resolved issues regarding shipped orders.
Stay at Home Mom
Home Mom
Rockford
01.2014 - 12.2017
- During this time, I was a stay-at-home mother working temporary jobs within the healthcare industry.
Education
Medical Billing & Coding - Certificate AHIMA Credentialed
Rasmussen College
Rockford, IL09-2020
General Studies - Some College
Rock Valley College
Rockford, IL08-2002
Skills
- Grievances and Appeals
- Electronic Medical Records
- Customer Service
- Microsoft Office and Outlook
- Medical Terminology
- Billing and Coding
- Medicare and Medicaid claims
- HIPAA Compliance
- CMS Guidelines
Certification
- CCA
- AHIMA Certified Coding Assistant
- November 2020 to July 2023
Additional Information
Authorized to work in the US for any employer
Timeline
Inbound Contacts Representative 2 (full Time)
Humana
07.2024 - Current
Inbound Contact Service Representative 1
Humana
11.2022 - 07.2023
Insurance Reimbursement Specialist
CareMetx, LLC-Bethesda
12.2021 - 02.2022
Sales Fulfillment Coordinator
Taylor Company
04.2017 - 08.2020
Stay at Home Mom
Home Mom
01.2014 - 12.2017
Medical Billing & Coding - Certificate AHIMA Credentialed
Rasmussen College
General Studies - Some College
Rock Valley College