Kristen James
Houston,TX
Summary
Self-motivated individual with an aptitude for learning new tasks quickly and performing them
efficiently and accurately as possible. Eager to obtain a position with a stable company with an
opportunity for growth as well as advancement, where my career will develop and grow alongside the
company’s own success.
Overview
15
15
years of professional experience
Work History
Insurance Service Representative
Anthem, Inc
11.2021 - 12.2022
- Verify insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframe (High call volume)
- Booked appointments for transportation pickup
- Monitored claims and physician-related services
- Handled billing issues and order inquiries
- Assisted members with reading and understanding EOB
- Processing orders, forms, applications, and requests
- Acknowledging and Keeping records of customer interactions, transactions, comments, and complaints
- Providing feedback on the efficiency of the customer service process
- Ensure customer satisfaction and provide professional customer support.
- Documented customer interactions and transactions for accurate, up-to-date records.
- Provided primary customer support to internal and external customers.
- Determined appropriateness of payers to protect organization and minimize risk.
- Communicated verification and authorization status updates with Type department to facilitate decision-making for patient admissions and insurance coverage.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Posted payments to accounts and maintained records.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient finances, records, and health statuses.
- Set up customer payment plans to cover annual policies and renewals.
Customer Service Support Specialist
Veterans Evaluation Services
02.2018 - 03.2020
- Place outgoing and receive high volume incoming calls to and from Veterans regarding compensation and pension exams and properly authenticate each caller before verifying or releasing any information
- Obtain scheduling availability and traveling availability of Veterans and confirm or reschedule appointments
- Explain policies and procedures of VES and the VA to Veterans who are unfamiliar with our company
- Explain the purpose of attending required exams, explain approximate time frames for returning reports/documents to the VA, and explain the process for travel reimbursement
- Status letters to custodian
- Patient Account
Insurance Customer Service Representative
Patient Account Services
Houston, TX
11.2013 - 09.2017
- Monitor accounts to identify past due debts and take action to encourage timely debt payments
- Update account status records and collections efforts
- Report on collection activity and accounts receivable status
- Contact insurance companies for claim processing and reimbursement
- Arrange payment schedules, generate billing entries, print or email bills and create reports
- Coordinate with insurance companies to resolve payment problems and reimbursement issues
- Billing via electronic and hardcopy submission
- Obtain supporting documentation regarding insurance follow-up efforts
- Identify contractual and administrative adjustment
- Obtain claim status via the telephone, internet and/or fax
- Obtains demographic, insurance and financial information from patient or guarantor
- Enters information in computer system with a high degree of accuracy
- Posts payments in the computer system and generates the appropriate patient receipts
Customer Service Team Lead
Dish Network
06.2008 - 11.2013
- Give constant direction to team members to ensure that all customer inquiries are rightfully attended to on time and in the best way possible to give them satisfaction
- Answering calls and assisting customers with all requests or inquiries concerning services, products, billing, and equipment, claims, and reports problem areas
- Observe performance of team members to identify their strengths and weakness and plan to strengthen their lose ends
- Create and implement work procedures that will enhance the organization and departmental service delivery, operating procedures and standards
- Trained and supervised team of customer service representatives in providing quality service to customers.
- Resolved customer service issues using company processes and policies and provided updates to customers.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered product and service questions, suggesting other offerings to attract potential customers.
Education
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Jack Yates High School
2008
Skills
- Computer operation
- Citrix
- Computer skills
- ICD-10
- Typing
- Epic
- Analysis skills
- Medical billing
- Medical records
- Medical collection
- Customer support
- Employee orientation
- CRM software
- Active Directory
- Cold calling
- EMR systems
- Insurance verification
- Microsoft Outlook
- Live chat
- Oracle
- Accounts receivable
- Microsoft Excel
- Salesforce
- Medicare
- IVR
- Infusion
- Home care
- DME
- CPT coding
- Negotiation
- Windows
- Sales
- SharePoint
- Documentation review
- Content management systems
- FTP
- HIPAA
- Teaching
- LMS
- High call volume (10 years)
Timeline
Insurance Service Representative
Anthem, Inc
11.2021 - 12.2022
Customer Service Support Specialist
Veterans Evaluation Services
02.2018 - 03.2020
Insurance Customer Service Representative
Patient Account Services
11.2013 - 09.2017
Customer Service Team Lead
Dish Network
06.2008 - 11.2013
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Jack Yates High School
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