Margaret Pisane
586-303-6692
Plant City,Florida
Summary
Friendly and engaging team players and leader able inspire others to perform their best. Detailed oriented and experienced claim processor, seeking a position with an organization that I can become a member of the team and utilize my claim processing skills and provide excellent service. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
21
21
years of professional experience
4
4
years of post-secondary education
Work History
FAMILY DOLLAR
07.2001 - 10.2022
- I waited on customers to make sure they were able to find items that they came to purchase
- Ran the cash register to check out customer’s purchases and restocked the front end to make sure all items were available for purchase.
CCS Medical
01.2009 - 01.2020
WILLIAM BEAUMOUNT HOSPITAL
- 01.2011
- Reviews claims to make sure patients qualify for diabetic pumps and continuous glucose monitors
- Met all attendance requirements
- Followed all Medicare, Medicaid, HIPAA and private insurance regulations while abiding by companies' policies and procedures
- Met all productivity goals
- Brought any problems to the attention of management that affected productivity
- Always maintained a high degree of confidentiality due to access HIAPP information., Handle the varication of insurance for outpatient services for patients
- Notified patients of deductibles and co-insurance
- Regularity calls insurance companies to follow up on claims processing
- Explores other payment options on who is liable
- Example MVA
- Subrogation
- Contacts policy holder when needing additional information
- Worked referrals and authorizations when required.
SOUTHERN HOSPITAITY
01.2019 - 01.2020
- Worked in inventory to make sure all products were logged, counted, and put on the shelves for customers to purchase
- Rideshare with Lyft and Uber from Dec 2018 to 2020
- Gave clients rides to their requested destination using the Uber and Left platform
LOWES
01.2017 - 01.2018
- Scan customers' orders to ensure that prices and quantity are correct and collect payments
- Assist customers by explaining or recommending items that will assist the customer with their projects
- Did all refunds and exchanges for the customers
- Balancing the cash register and generating credit and debit reports.
EHIM
01.2005 - 01.2015
- Processed all insurance claims by reviewing customers policy in relationship to the claim being processed
- Excellent analytical, critical thinking and problem-solving skills
- Attention to detail with the ability to multitask
- Able to meet production and quality standards
- Daily follow up on claim correspondence
- Managed a wide variety of customer service and administration tasks to resolve customer issues quickly and efficiently
- Research and process different sets of medical plans as well as benefits
- Responded to inquiries from participants and providers in relationship to their medical benefits
- Solved all issues related to claim adjudication and customer complaints by e-mail or phone
- Worked with coordination of benefits, subrogation and adjusting on claims
- Conflict resolution
- Problem solving, reliability and multitasking
- Adaptability and troubleshooting
- Garet
Education
BBA - General
Oakland University
Rochester, MI 06.1991 - 09.1995
Skills
- Problem-Solving
- Research
- Active Listening
- Good Telephone Etiquette
- Google Workspace
- Time Management
- Customer Relations
- Remote Office Availability
- Medical Terminology
- Microsoft Word
- Healthcare Common Procedure Coding System (HCPCS)
- Claims Investigations
- Review Cases
- Critical Thinking
Work Preference
Work Type
Full TimePart TimeLocation Preference
RemoteHybridImportant To Me
Work from home optionWork-life balanceTimeline
SOUTHERN HOSPITAITY
01.2019 - 01.2020
LOWES
01.2017 - 01.2018
CCS Medical
01.2009 - 01.2020
EHIM
01.2005 - 01.2015
FAMILY DOLLAR
07.2001 - 10.2022
BBA - General
Oakland University
06.1991 - 09.1995
WILLIAM BEAUMOUNT HOSPITAL
- 01.2011