Heather Canterbury
Spout Spring,VA
Summary
Accomplished Customer Service Supervisor at Piedmont Community Health Plan, adept in claims processing and fostering effective collaboration. Leveraged EMR/EHR expertise and analytical problem-solving to enhance departmental performance, streamline workflows, and significantly improve customer satisfaction. Proven track record in health records management and insurance regulations, ensuring compliance and operational excellence.
Overview
12
12
years of professional experience
Work History
Customer Service Supervisor
Piedmont Community Health Plan
Lynchburg, USA
07.2023 - Current
- Addresses denial reasons for providers by researching E/M codes, HCPCS, and CPT codes.
- Evaluate insurance claims to certify accurate settlement.
- Developed and sustained reports to evaluate departmental performance.
- Conducted interviews and recommended effective hires.
- Designed workflows to streamline processes.
- Ensured swift problem-solving by effectively handling escalated inquiries.
- Evaluated customer feedback to determine service trends.
- Created training materials for onboarding new hires.
- Coordinated shift assignments to accommodate coverage needs.
- Ensured rapid resolution of customer issues through inter-departmental collaboration.
- Communicated detailed guidelines on benefits and eligibility requirements with customers.
- Supported claimants, providers, and clients with their claim-related inquiries.
Customer Service Representative
Piedmont Community Health Plan
Lynchburg, USA
08.2020 - 07.2023
- Served as intermediary between healthcare providers and members.
- Streamlined communication flow for brokers, providers, and members.
- Handled telephone payments for members and groups.
- Conveyed relevant claim information to members and clinicians during reviews.
- Generated reports for both members and providers.
- Obtained member consent to discuss insurance information with third parties in compliance with HIPAA regulations.
- Provided clear and accurate details while managing calls professionally.
- Addressed emails, voicemails, and secure messages in a timely manner.
- Enhanced team skills through comprehensive training.
Medical Records Clerk/Prior Authorization Associate
Lynchburg Pulmonary Associates
Lynchburg, USA
01.2019 - 08.2020
- Ensured adherence to hospital and governmental regulations.
- Directed efforts to resolve authorization issues.
- Ensured compliance with all healthcare regulations.
- Coordinated with insurance providers to obtain necessary authorizations.
- Coordinated physician peer reviews.
- Indexed documents into the digital health record database.
- Indexed documents into the digital health record database.
- Ensured timely completion of record request submissions.
- Verified insurance eligibility prior to releasing protected health information.
Medical Receptionist
Lynchburg Pulmonary Associates
Lynchburg, USA
03.2018 - 01.2019
- Greeted and checked in patients, updating patient information in computer system.
- Verified insurance coverage for appointments and collected co-payments as required.
- Prepared charts for new patients, ensuring all necessary forms were completed correctly.
- Scheduled patient appointments, verifying accuracy of appointment times with providers.
- Answered incoming calls, responding to inquiries from patients and other medical offices.
- Executed data entry for billing processes.
- Facilitated referral processing for specialized medical care needs.
- Returned calls promptly to maintain efficient communication.
- Conducted patient outreach to secure and verify appointment details.
- Retrieved and uploaded incoming faxes into patient charts.
Universal Banking Associate
First Bank
Dillwyn, USA
04.2015 - 03.2018
- Assisted customers with opening new accounts, processing deposits and withdrawals, and providing account information.
- Performed daily operations such as balancing cash drawers and reconciling transactions.
- Maintained a thorough knowledge of bank products, services, policies, procedures, regulations and compliance requirements.
- Resolved customer inquiries in a timely manner while adhering to all applicable laws and regulations.
- Analyzed customer data to identify potential cross-selling opportunities for additional bank products and services.
- Generated precise cash and change orders for customers and ATMs.
- Kept teller window orderly and functional.
- Performed thorough quarterly audits of vault and ATMs, ensuring no discrepancies.
- Continuously learned about banking solutions via VAC courses.
Teller
Bank of America
Dillwyn, USA
09.2012 - 04.2015
- Received and processed customer transactions, including deposits, withdrawals, loan payments and other banking services.
- Validated customer identification to comply with regulations.
- Maintained consistent accuracy in daily cash drawer balancing.
- Executed precise routine transactions, maintaining exceptional service levels.
- Supplied comprehensive details of accounts to clients when necessary.
- Managed the processing of both local and global wire transactions.
- Examined inconsistencies between recorded transactions and cash totals.
- Cross-sold various bank products based on customer requirements.
- Conducted daily reconciliation of teller drawer within limits.
- Processed significant amounts of currency with precision.
Education
Medical Coding Professional-CPC -
Penn Foster
11.2024
HIGH SCHOOL DIPLOMA -
Penn Foster
Skills
- Customer Engagement
- Claims Processing Expertise
- Detail-Oriented Data Input
- Health Records Management
- EMR / EHR
- Medical office administration
- Human Anatomy Expertise
- Effective Collaboration Skills
- Analytical Problem Solving
- Flexible Problem-Solving
- Insurance regulations
References
References available upon request.
Timeline
Customer Service Supervisor
Piedmont Community Health Plan
07.2023 - Current
Customer Service Representative
Piedmont Community Health Plan
08.2020 - 07.2023
Medical Records Clerk/Prior Authorization Associate
Lynchburg Pulmonary Associates
01.2019 - 08.2020
Medical Receptionist
Lynchburg Pulmonary Associates
03.2018 - 01.2019
Universal Banking Associate
First Bank
04.2015 - 03.2018
Teller
Bank of America
09.2012 - 04.2015
Medical Coding Professional-CPC -
Penn Foster
HIGH SCHOOL DIPLOMA -
Penn Foster
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