Open To Work
MAJORIE JANVIER
FL
Summary
Detail-oriented billing professional with a strong track record in managing high volumes of claims and ensuring compliance with quality assurance standards. Resourceful in resolving discrepancies and enhancing reimbursement outcomes through effective communication and problem-solving. Committed to driving efficiency and service value in support of organizational objectives.
Overview
12
12
years of professional experience
Work History
Billing Representative III
NYU Langone Health
Boynton Beach, Florida
08.2023 - Current
- Managed insurance claim submissions and tracked payment statuses effectively.
- Conducted follow-ups with third-party payers to expedite claim resolutions.
- Corrected errors and resubmitted claims while ensuring compliance with FGP guidelines.
- Generated and appealed denied claims, enhancing reimbursement outcomes.
- Utilized CBO pathways to resolve claim discrepancies and secure necessary authorizations.
- Assisted in training new staff on proper billing procedures and protocols.
- Supported department supervisors with special projects and staff training initiatives.
- Participated in workgroups, contributing ideas that improved billing processes.
Senior Claims Service Adjuster
United Healthcare
Miami, FL
11.2016 - 11.2022
- Reviewed and resolved Medicaid and Medicare claims to ensure compliance and accuracy.
- Utilized various software applications to evaluate claims, review coverage details and process payments.
- Analyzed claim reports to ensure accuracy of payment calculations, policy limits and other pertinent information.
- Managed high volume of individual claims, consistently meeting departmental quality assurance standards.
- Resolved Provider complaints by providing timely updates on claim status, enhancing customer satisfaction.
- Reviewed payments issued by third party administrators for accuracy prior to issuing final payments on behalf of the company.
- Applied problem-solving techniques to identify solutions that meet both customer needs and company goals.
- Demonstrated ability to effectively communicate with all levels of management, staff and customers in a professional manner.
- Participated in professional development seminars and webinars to stay abreast of industry best practices.
Senior Call Center Representative
United Healthcare
Miami, FL
12.2014 - 11.2016
- Exceeded performance metrics related to call time, quality, and customer satisfaction.
- Met performance goals and call center metrics in fast-paced performance setting.
- Streamlined processes for handling call volume, enhancing quality standards.
- Collaborated closely with supervisors and managers to ensure successful resolution of customer complaints or concerns.
- Pinpointed improvement opportunities in call center practices, contributing to overall service enhancement.
- Built trust with customers through personalized conversations.
- Managed difficult situations calmly and effectively while maintaining a positive attitude towards customers.
Education
Nursing -
University Notre Dame
08-2010
Skills
- Claims review processes
- Billing code knowledge
- Billing accuracy checks
- Claim submission accuracy
- Patient billing management
- Claims validation techniques
- Billing policies training
- Database management
- Process optimization methods
- Attention to detail
- Time management proficiency
- Problem-solving abilities
- Team collaboration skills
- Communication and interpersonal skills
- HIPAA compliance
Timeline
Billing Representative III
NYU Langone Health
08.2023 - Current
Senior Claims Service Adjuster
United Healthcare
11.2016 - 11.2022
Senior Call Center Representative
United Healthcare
12.2014 - 11.2016
Nursing -
University Notre Dame