Kimberly Shirey

• Developed new strategies for customer retention activities.
• Conducted performance reviews and provided feedback to managers on employee performance.
• Reported issues and recognized development areas to eliminate repeat occurrences.
• Built constructive customer relationships to improve loyalty and recommendations.

1. Process incoming requests from Service Providers and Plan holders; logging pertinent information accurately and efficiently, according to company standards.
2. Ensure work order meets Plan guidelines (e.g. effective dates, coverage, and limitations). Communicate effectively and ask pertinent questions to determine coverage; authorize or deny coverage in whole or in part; assist with service needs; educate callers as to Plan coverage, trade call fees, etc.
3. Negotiate best pricing where appropriate.
4. Escalate calls through the proper channels, when necessary.

• Volunteered to help with special projects of varying degrees of complexity.
• Surpassed team goals by partnering with colleagues to implement best practices and protocols.
• Managed filing system, entered data and completed other clerical tasks.
• Organized logistics and materials for each meeting and took detailed notes for later dissemination to key stakeholders.

• Researched and identified potential new markets.
• Negotiated contracts and terms of sale with potential customers.
• Identified and solicited sales prospects in agency databases.
• Conducted research and identified market trends to develop better strategies for sales.

• Processed debtor payments and updated accounts to reflect new balance.
• Reconciled statements with patient records.
• Located customers with overdue accounts and solicited payment in compliance with fair debt collection practices.
• Posted payments and processed refunds.

• Provided knowledgeable service and support for all customer needs.
• Coordinated with operations staff to resolve service problems and boost client satisfaction.
• Supported loan process by gathering loan documentation and assisting with loan processing and general loan analysis.
• Communicated with clients regarding account services, statements, and balances.

• Answered phone calls and messages for [Number]-physician [Type] medical facility, scheduling appointments, and handling patient inquiries.
• Complied with HIPAA guidelines and regulations for confidential patient data.
• Chased insurance companies to achieve accurate and timely payments.
• Performed various administrative tasks by filing, copying and faxing documents.

Submitted claims to Medicare and followed up to ensure claims were resolved in a timely manner. Contacted insurance company to confirm treatment status.
• Conducted research, gathered results, and interpreted data to resolve claims.
• Confirmed ore-existing conditions and injuries by speaking with clients and reviewing medical records. Generated closing statements and demands in a high volume, fast paced setting.
Selected Contributions:
• Decreased time to market by 100% after spearheading the re-designing and effective implementation of new company procedures.
• Handled a volume of cases, ensuring each case with giving adequate attention and no tasks left undone.

• Monitored customer accounts for payment delinquency and initiated collection efforts.
• Initiated repossession process or service disconnection upon failure of other collection methods.
• Responded to customer inquiries and provided detailed account information.
• Monitored flags and resolved urgent items with accuracy and efficiency.

• Wide experience in data entry and medical claim processing
• Deep knowledge of DRGs, Health Maintenance Organization (HMO) and IPA claim payments adjudication
• Familiarity about rules and regulations at DMHC and CMS
• Proficient in submission and editing claims electronically and other on-line systems for claim and problem registration.
• Ability to process claims for surgery, radiology, lab and medicine for CMS 1500 and CMS 1450 claim forms.
• Ability to comprehend DVRs and related benefits.
Selected Contributions:
• Improved customer satisfaction by being a part of the "Red Hot" team to insure payment was accurately submitted on time in an efficient manner.