Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

James Blake

Altamonte Springs,FL

Summary

Devoted to giving every customer a positive and memorable experience. Highly motivated, adaptable employee with strong work ethic, professional, reliable and dependable, who thrives on new challenges, possesses exceptional interpersonal and communication skills, works effectively with minimal supervision or is comfortable in an office setting. Seeking a new opportunity to bring excellent problem-solving and experience, servicing the biotech/pharmaceutical and medical industry in a specialty digital HUB services and technology company.
As a Specialty Pharmacy and Reimbursement Specialist, my experience includes, COB verification, prior authorization, primary and secondary insurance coverages, data entry of CPT codes, DX codes, J-codes, Medicare and Medicaid coverages and patient reimbursement.

Overview

39
39
years of professional experience
1
1
Certification

Work History

Certified Medical Reimbursement Specialist

CareMetx, LLC
Lake Mary, FL
12.2023 - Current
  • Resolved discrepancies between provider bills and insurance companies' payment policies.
  • Identified potential billing errors or issues that may result in delayed payments or rejections by payers.
  • Identified trends in denied claims through analysis of data collected from payer sources.
  • Updated database systems with new codes or other changes as needed.
  • Identified discrepancies and carrier issues regarding billing and reimbursements.
  • Protected medical office operations and integrity by keeping patient information confidential.
  • Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
  • Performed insurance verification, pre-certification and pre-authorization.
  • Participated in workshops, seminars and training classes to gain stronger education in industry updates and federal regulations.
  • Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
  • Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
  • Participated in training sessions on new software programs used for verification purposes.
  • Updated patient and insurance data and input changes into company computer system.
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Navigated through multiple online systems to obtain documentation.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Adhered to HIPAA requirements to safeguard patient confidentiality.
  • Compiled and coded patient information or data in appropriate computer system.

On-Boarding and Implementation Engineer

Spectrum Business Connect with RingCentral
Maitland, FL
10.2022 - 09.2023
  • Create accounts and train new Spectrum Business Connect with RingCentral customers
  • Assit new customers with initial set-up of RingCentral account download including activation of accounts through the RingCentral Admin Portal and RingCentral App.
  • Guide customers through to Port telephony numbers over to RingCentral using one-on-one screen sharing
  • Set up Auto Receptionist, Call Handling, New Users, New IVR's, Call Groups, Schedules and Company Rules
  • Add Fax & Toll Free telephone numbers as necessary
  • Provision new VOIP phones to the RingCentral Admin Portal
  • Explain in detail the RingCentral App user interface to customers and how to find help using RingCentral University.
  • Guide customers through text messaging set up using 10DLC TCR Registration.

Business Sales Activation Specialist

Spectrum
Maitland, FL
04.2021 - 10.2022
  • Assist Spectrum Account Executive Sales and Channel Partners to Activate and complete the Sale process to a successful conclusion
  • Key in business sales orders for the Account Executives and Channel Partners.
  • Schedule Installation dates for Internet, Telephony and Video for Business Sales Executives and Channel Partners.
  • Complete orders for Business Mobile Sales for Sales Executives and Channel Partners.
  • Assisted Techs with helping get business customer set up and all the right codes entered for the install date completion.

Residential Retention Specialist

Spectrum/Charter Communications
Lake Mary, FL
03.2019 - 04.2021
  • Analyzed customer feedback and developed new techniques to ensure customer retention.
  • Performed customer negotiations to reach fair conclusion for both business and customer.
  • Explained new products and services to customers.
  • Resolved customer service or billing issues by exchanging merchandise, refunding money or adjusting bills.
  • Retained customers using every allowable tool including selling Mobile Service and mobile phones to help customer save money and by lowering their overall monthly bill.

Aerial Photographer/Pilot/Sales Rep

Aerial Views USA
Orlando, FL
02.1992 - 03.2021
  • Responded to prospects' questions with persuasive communication skills and in-depth knowledge of available products and services.
  • Broke down objections using friendly, persuasive strategies.
  • Generated leads with successful cold calling of Business Aerial Photo prospects and skilled use of persuasive communication skills.
  • Developed key customer relationships to increase sales.
  • Placed orders and answered customer questions in-person, through email and over phone to maximize customer service.
  • Presented products and services to prospective and existing customers to meet client needs.
  • Developed customized sales techniques to successfully sell and upsell services to new and existing clients.
  • Created successful strategies to develop and expand customer sales.
  • Followed-up with clients after installations to assess quality service and customer satisfaction.
  • Drove substantial sales through suggestive selling and by promoting add-on purchases.
  • Developed targeted lists and new business opportunities, accelerating sales process to achieve results.
  • Leveraged CRM system to manage sales activities and track sales performance.
  • Greeted customers to determine wants or needs.
  • Computed purchases and received and processed cash or credit payment.

Business Owner/Operator

Blake & Associates Insurance, Inc.
Longwood, FL
02.1985 - 01.1992
  • Evaluated and pursued sales leads obtained through direct referrals, networking, marketing, cold-calling and lead databases.
  • Presented and clearly explained insurance policy options based on clients' needs and goals.
  • Researched coverage and premium options and supplied clients with best coverage available for individual needs.
  • Interviewed prospective clients to learn about financial needs and discuss existing coverage.
  • Promoted client retention through high-quality service and follow through.
  • Made appointments with potential clients to discuss products.
  • Provided information and answered questions via personal meetings, telephone calls.
  • Consulted with clients to develop customized insurance policy packages and advised clients on investment opportunities to safeguard assets while minimizing cash flow.
  • Managed 8 staff members, creating strategic plans, administering benefits and directing employee relations to promote optimal productivity.
  • Interviewed prospective clients to gather information on financial needs and discuss existing coverage.
  • Built up the Insurance Agency book of business volume to over 2.3 million since its first start.

Education

Bachelor of Science -

Florida States University College of Business
Tallahassee, FL
12.1984

High School Diploma -

Lyman High School
Longwood, FL
05.1981

Skills

  • Verbal and Written Communication
  • Support Services
  • Active Listening
  • Organizational Skills
  • Attention to Detail
  • Interpersonal Skills
  • Team Building
  • Planning and Coordination
  • Training and Mentoring
  • Client Relations
  • Account Management
  • Good Communication Skills
  • Customer Relationship Management (CRM)
  • Telephone Etiquette
  • Call Center Operations
  • Data Analysis
  • Microsoft Office
  • Relationship Building
  • Conflict Resolution
  • Customer Service
  • Insurance Verification
  • Problem-Solving
  • Multitasking and Prioritization
  • HIPAA Compliance
  • Customer Account Management
  • Database Management
  • Word Processing
  • Work Planning and Prioritization
  • Customer Contact
  • CRM Software
  • Healthcare Regulations
  • Medical Coding
  • Medicaid Knowledge
  • Medical Billing
  • Healthcare Knowledge
  • Insurance Coverage Verification
  • Critical Thinking
  • Data Entry
  • CMS Guidelines
  • Effective Communication Skills

Certification

  • Salesforce Administrator Training Certified - 2023
  • Introduction to Cloud Computing Certified - 2023
  • Introduction to Artificial Intelligence Certified - 2023
  • Supervisor Management Tools (Contact Center) RingCentral
  • Administrator Management (Contact Center) RingCentral
  • Admin (MVP Advanced) RingCentral
  • Salesforce Agent-Fully Integrated Lighting Experience (Contact Center)

Timeline

Certified Medical Reimbursement Specialist

CareMetx, LLC
12.2023 - Current

On-Boarding and Implementation Engineer

Spectrum Business Connect with RingCentral
10.2022 - 09.2023

Business Sales Activation Specialist

Spectrum
04.2021 - 10.2022

Residential Retention Specialist

Spectrum/Charter Communications
03.2019 - 04.2021

Aerial Photographer/Pilot/Sales Rep

Aerial Views USA
02.1992 - 03.2021

Business Owner/Operator

Blake & Associates Insurance, Inc.
02.1985 - 01.1992

Bachelor of Science -

Florida States University College of Business

High School Diploma -

Lyman High School

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James Blake