Joandra Thomas
Jacksonville,FL
Summary
Top-notch communicator with excellent time management, administrative and customer service skills. Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires and providing customized solutions to build loyalty.
Overview
13
13
years of professional experience
Work History
SBO Billing/Claims Specialist (Hybrid)
Baptist Health
06.2021 - 01.2024
- Accept multiple back-to-back calls utilizing various applications on multiple screens, and properly enter all patient, provider, and imaging center data
- Properly handle and verify patient records under HIPPA and PHI, and secure confidentiality for each call
- Review and verify other insurance coverage information in submitted claim
- Reviewing claims to make sure Cpt/ICD-10 were properly used
- Validate the accuracy of medical codes provided in claim submissions
- Reviewing denied claims by updating Diagnosis codes, patient information, Adding PA’s
- Speaking with insurance companies regarding reimbursement
- Identify discrepancies, errors, or missing information on claims
- Speaking with customers to convey information provided by insurance companies
- Speaking with Physicians to verify Cpt (Services that were rendered) once claims was denied
- Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines
- Utilize multiple computer applications simultaneously
- Reading and reviewing claims requesting additional medical documentation
- Adding and updating procedures codes
- Sending claims for appeal if insurance is denying it
- Working in Epic to electronically billed Claims to all Major Insurance Companies
- Manually Faxing claims, Or Mailing out UB04/ CM-1500
- Speaking with Patients to verify insurance information
- Analyze account benefit plans to ensure claims align with coverage and policies
- Updating patients every 30 days regarding the claims process
- Working in Teams, Microsoft Word, Excel, outlook to keep track of claims
- Meet or exceed quality and productivity goals.
Customer Service/ Dispatcher (Remotely)
ADT Security Services
02.2018 - 05.2021
- Outbound and inbound Call Center Remotely
- Licensed operator to work in all States mandating requirements
- Proficient in the verification and dispatching of alarms to police/fire agencies
- Being able to Differentiate the types if signals and the SOP’s for each signal
- Working under close supervision
- Monitoring Security System Remotely
- Meeting Stats and productivity standards set
- Must keep abreast of both company and central station policies
- Dealing with Life Safety Measurement, Keeping customer safe
- Notifies customers of non-emergency signals
- Meet or exceed quality and productivity goals
- Notifies responders on emergency signals after dispatch
- Processes basic data changes to customer accounts
- Must be able to manage signals from one location/area and TTY stations
- Verifies, respond to, and Dispatches on Emergency Signals.
Customer Service Rep (Remotely)
Comcast Universal Inc
01.2016 - 01.2018
- Accept multiple back-to-back calls utilizing various applications on multiple screens, and properly enter all patient, provider, and imaging center data
- Providing the right experience to customers for billing, repair, retention, and sales inquiries or interactions
- Troubleshoots and resolves technical problems and other general account inquiries in a single customer interaction to create promoters and enhance the customer experience
- Effectively works to build a consultative relationship with the customer to create understanding
- Sets clear expectations by providing accurate information and transparent communications
- Navigating through the billing system to help customers find deals more suitable for them
- Explanations of billing while doing everything within power the instill trust w/ customer
- Owning the customer experience by thinking of ways to put the customer first
- Setting appointments for technicians to come out to set up new customer /or fix existing customer issues
- Communications in warm and friendly manner through both verbal and written means via various
- Meet or exceed all performance metrics through accurate call handling and high-quality calls
- Working in Microsoft outlook and WebEx to stay connected with colleagues
- Working in Messager, weber to stay connect to co workers.
Customer Service Advocate (Remotely)
UHC/OPTUMRX SERVICES Inc
10.2013 - 12.2016
- Accept multiple back-to-back calls utilizing various applications on multiple screens, and properly enter all patient, provider, and imaging center data
- Review and verify other insurance coverage information in submitted claim
- Analyze account benefit plans to ensure claims align with coverage and policies
- Pharmaceutical healthcare Help Desk
- Setting up home delivery Accounts
- Helping member better understand their benefits Regarding their Prescriptions per their Formulary
- Submitting Prior Authorization / Explain to member the important of the PA
- Submitting Overrides
- Utilize multiple computer applications simultaneously
- Breaking down Copays, Deductibles and Max out of Pockets
- Working in Systems Such as Iris and Navigator to assist members with their health benefits
- Submitting claims for Research and Resolution Department
- Processing Medicare Claims/Overrides
- Explanation of Benefits
- Insurance Claims
- Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines
- Properly handle and verify patient records under HIPPA and PHI, and secure confidentiality for each call
- Meet or exceed all performance metrics through accurate call handling and high-quality calls
- Navigating through Iris and Navigator software to help assist members
- Working in Microsoft outlook.
Receptionist /Technician
LENS CRAFTER/MACK EYE CARE
08.2010 - 09.2012
- Per screening patients by using digital clarify, checking pressures, also taking pictures of their eye
- Handling contacts lens by prescribing and teaching customer how to place contact lens in their eyes
- Processing Claims with insurance providers, quoting Copays for provided services
- Front desk, medical office, and front office
- Greeted patients and customers as they entered
- Checked in patients and clients
- Answered the phone for a company of over one hundred employees
- Made calls to 30-40 patients a day
- Made appointments for patients, visitors, and customers
- Verified insurance and copayments
- Tracked medical histories and medical forms
- Processed payments and copays
- Entered patient insurance information into the database
- Documented financial data
- Meet or exceed quality and productivity goals
- Faxed, copied, and scanned documents
- Sent prescriptions to the appropriate department
- Kept up-to-date records on Microsoft office and Excel.
Education
GED -
Florida State College At Jacksonville
Jacksonville, FL07.2016
Skills
- Customer Relations
- Expert Problem Solving
- Quality Assurance
- Active Listening
- Critical Thinking
- Call center experience
- Computer Proficiency
- Microsoft Excel
- Microsoft Outlook
- Live chat support
- Claim Denial Resolution
- HIPAA compliance awareness
Timeline
SBO Billing/Claims Specialist (Hybrid)
Baptist Health
06.2021 - 01.2024
Customer Service/ Dispatcher (Remotely)
ADT Security Services
02.2018 - 05.2021
Customer Service Rep (Remotely)
Comcast Universal Inc
01.2016 - 01.2018
Customer Service Advocate (Remotely)
UHC/OPTUMRX SERVICES Inc
10.2013 - 12.2016
Receptionist /Technician
LENS CRAFTER/MACK EYE CARE
08.2010 - 09.2012
GED -
Florida State College At Jacksonville