Karen Smith
Orange Park,FL
Summary
Proven Patient Account Representative with a strong background in insurance verification and billing, honed at AmeriHealth Caritas. Excelled in enhancing customer satisfaction and streamlining billing processes, demonstrating exceptional problem-solving skills and empathy. Achieved significant improvements in claims efficiency and customer service delivery,
leveraging expertise in database management and interpersonal communication.
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
10
10
years of professional experience
Work History
Patient Account Rep Remote
AmeriHealth Caritas Family Of Companies
10.2020 - 12.2023
- Assisted colleagues during peak periods or absences, showcasing teamwork skills while maintaining personal workload demands efficiently.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Remote Call center environment assisting members with their insurance needs.
- Excelled in all requirements needed for my job performance.
- I was employed for LOB 6400 and received training for FL LOB 2100
Patient Account Representative
Florida Blue Cross
09.2015 - 10.2018
- Assisted colleagues during peak periods or absences, showcasing teamwork skills while maintaining personal workload demands efficiently.
- Posted payments and processed refunds.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.
- I am proficient in an additional 15 computer programs during my time there.
- Handled small groups with setting up their insurance needs.
- Excelled in all requirements needed for my job performance
- Facilitated smooth communications between patients, providers, and insurers, fostering an atmosphere of trust and collaboration.
- Streamlined billing processes for increased efficiency in managing patient accounts.
- Managed a portfolio of multiple accounts, ensuring timely delivery of products and services while maintaining strong relationships with clients.
- Processed provideraccounts/payments and updated accounts.
- Interpreted financial data to identify trends and opportunities.
Patient Account Representative
Aetna-USTTech Solutions
03.2014 - 02.2015
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Temporary position assisting members with their insurance needs
- I am proficient in over 20 computer programs.
- Benefits and eligibility training Claims follow up and appeal
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Streamlined billing processes for increased efficiency in managing patient accounts.
- Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
- Ensured compliance with healthcare regulations while processing claims and managing patient accounts.
- Responded to patient, family and external payer inquiries.
Marketing Administrator
Florida Blue Cross Blue Shield
09.2013 - 03.2014
- Conducted market research to assess customer needs and preferences.
- Streamlined marketing processes, resulting in increased efficiency and reduced costs.
- Maximized event impact through meticulous planning, promotion, and execution of trade shows and conferences.
- Setting up Venues for providers
- This was a temporary position
- Strengthened company reputation through strategic public relations initiatives and media outreach.
- Collaborated with marketing team to develop compelling collateral materials, driving interest in products or services offered.
Education
Associate of Applied Science - Business Administration And Management
Middlesex County College
Edison NJ06.1974
Skills
- HIPAA Compliance
- Insurance Verification
- Insurance Billing
- Medical Billing
- Customer Service
- Customer Support
- Data Entry
- Customer Satisfaction
- Call Center Customer Service
- Written and oral communication
- Call Center Operations
- Customer inquiries
- Complaint resolution
- Empathy Display
- Customer Correspondence
- Call Management
- Payment Processing
- LiveChat
- Product and service knowledge
- Documentation And Reporting
- Keyboarding
- Patience Maintenance
- Customer Needs Assessment
- Escalation management
- Eligibility Determination
- Account updating
- Database Management
- Account Management
- Problem-solving skills
- Customer communications
- Verbal and written communication
- Resolving issues
- Quality Assurance
- Inbound Phone Call Management
- Answering questions
- Gathering information
- Logging call information
- Communicating with clients
- Building rapport
- Interpersonal Skills
- Inbound phone calls
- Appointment Scheduling
- Quality Assurance Controls
- Training experience
- Calm disposition
- Customer service optimization
- Database Research
- Customer Relationship Management
- Product Knowledge
- Call Control
- Quality Control
- Fluent in English
- System Documentation
- Data Gathering
- Sales expertise
- Cash Handling
- Computer Skills
- Teamwork and Collaboration
- Understanding Customer Needs
- Inbound Call Management
- Issue and Complaint Resolution
- Calm Under Pressure
- Calm and Professional Under Pressure
- Customer Relationship Management (CRM)
- Following scripts
- Remote Office Availability
- Call Metrics
- Multi-Line Phone Systems
- Document and Records Management
- Data Management
- Relationship Building
Accomplishments
- Built productive relationships with patients and insurance companies, increasing payment rates.
- Resolved [Number] outstanding claims in first [Number] months on job.
Additional Information
• Many years of diversified business/customer service experience that includes successful performance in professional billing and payment processing of all types of insurance.
• Computer literate with the many computer systems which includes RBMA Systems, CRM, Siebel, Windows 10
Medic, Microsoft, MCNA, also to be noted each Insurance and Providers have their own systems Knowledgeable in CPT coding and medical terminology. • Experienced with various insurance contracts including HMO, PPO, Managed care, Medicare and Medicaid
• I have also worked in providers offices before the insurance companies past the 10 years listed on this resume.
Timeline
Patient Account Rep Remote
AmeriHealth Caritas Family Of Companies
10.2020 - 12.2023
Patient Account Representative
Florida Blue Cross
09.2015 - 10.2018
Patient Account Representative
Aetna-USTTech Solutions
03.2014 - 02.2015
Marketing Administrator
Florida Blue Cross Blue Shield
09.2013 - 03.2014
Associate of Applied Science - Business Administration And Management
Middlesex County College
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