Karen Capes
Fuquay-Varina
Summary
Recently retired and accomplished healthcare and customer service professional with a background in medical billing and insurance. Seeking a full/part time or flexible position to leverage my expertise. Known for strong communication skills, attention to detail and a commitment to delivering excellent customer service. Eager to remain actively engaged and support organizational success while supplementing retirement income.
Overview
45
45
years of professional experience
Work History
Sr. Manager
Bristol Myers Squibb
Princeton, NJ
02.2000 - 07.2024
- Directed cross-functional teams to optimize processes and improve operational efficiencies.
- Implemented data-driven decision-making frameworks to support organizational objectives and drive performance improvements.
- Oversaw budgeting processes, ensuring alignment with priorities.
- Provided strong leadership and training to enhance team productivity, morale and customer satisfaction.
- Established strong relationships with clients, customers and stakeholders, ensuring long-term partnerships, repeat business and high customer satisfaction.
- Facilitated timely resolution of customer issues by addressing concerns immediately and implementing corrective actions.
- Cultivated positive rapport with fellow employees to boost company morale, promote employee retention & ensure excellent customer service.
- Managed challenging customer situations with poise, ensuring respectful and constructive communication. to ensure each customer receives all necessary information to satisfy their concerns
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Claims Representative/Medical Office Manager
Medical Management Associates
Trenton, NJ
03.1990 - 09.1999
- Processed and adjudicated medical claims, ensuring compliance with regulations and various insurance companies.
- Educated customers about billing, payment processing and support policies and procedures.
- Responsible for overseeing daily operations, ensuring payments are posted accurately for 30 various specialty practices and hospitals for multiple insurance companies.
- Ensure each account at day's end is reconciled accurately to each practices deposit statements.
- Coordinated billing and insurance processes, ensuring timely reimbursement and financial accuracy.
- Created and managed electronic patient records, encompassing data entry and administrative functions related to insurance, billing, and accounts receivable.
- Collaborated with healthcare providers to resolve discrepancies and expedite claim resolutions.
- Provided training for new claims representatives on best practices for accurate claim processing.
- Evaluated complex claims involving multiple services, ensuring accurate payment distribution.
- Worked productively in fast-moving work environment to process large volumes of claims/payments to ensure meeting timelines set by each of our doctors.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Developed strong relationships with clients, facilitating trust and open communication during the claims process.
- Served as a subject matter expert on specialized claims, providing guidance and support to other team members when needed.
Claims Administrator
I.E. Shaffer & Company
Princeton, NJ
01.1980 - 12.1989
- Analyzed processed cut insurance payments and organized claims documentation to guarantee adherence to compliance requirements for 10 unions' medical and dental insurance.
- Managed workload by effectively prioritizing tasks to ensure timely completion of all claim-related responsibilities.
- Reviewed and modified multi-line claims in alignment with established standards and legal requirements to mitigate risk and ensure accuracy.
- Improved internal communication, effectively liaising between various departments to resolve issues.
- Elevated customer satisfaction by proactively resolving concerns and delivering precise claim information.
- Facilitated prompt claim payments to enhance operational efficiency through diligent monitoring of deadlines and follow-up on pending documents.
- Managed a high volume of daily claims, consistently meeting deadlines without compromising attention to detail or accuracy.
- Delivered exceptional customer service to clients through effective communication and problem resolution regarding insurance claims and benefits.
Education
Associate of Science - Medical/Dental Assistant
Mercer County Community College
Trenton, NJ05.1973
Skills
- Operations management
- Cross-functional collaboration
- Troubleshooting and problem resolution
- Documentation and reporting
- Cross-functional communication
- Corporate communications
- Teamwork and collaboration
- Team leadership
- Budget management
- Excellent communication
- Multitasking
- Customer relationship management
- Customer service
Timeline
Sr. Manager
Bristol Myers Squibb
02.2000 - 07.2024
Claims Representative/Medical Office Manager
Medical Management Associates
03.1990 - 09.1999
Claims Administrator
I.E. Shaffer & Company
01.1980 - 12.1989
Associate of Science - Medical/Dental Assistant
Mercer County Community College