Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Nicole Clemons

Oakland,CA

Summary

Dedicated customer service leader with over two decades of proven expertise in enhancing customer satisfaction and operational efficiency. Skilled in training, mentoring, and supervising new and current employees to deliver exceptional service experiences. Adept at working effectively unsupervised and quickly mastering new skills. Seeking to leverage extensive experience and leadership skills in a challenging customer-centric role.

Overview

24
24
years of professional experience
1
1
Certification

Work History

Telereceptionist

Directline Inc.
Berkeley, CA
06.2002 - 09.2022
  • Completed day-to-day duties accurately and efficiently.
  • Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
  • Displayed strong telephone etiquette, effectively handling difficult calls.
  • Maintained updated knowledge through continuing education and advanced training.
  • Took orders from customers over the phone and in person.

Medical Insurance Biller

Womens' Choice Clinic
Oakland, CA
01.2003 - 03.2004
  • Submitted electronic and paper claims to insurance companies for payment.
  • Monitored changes in government regulations affecting healthcare reimbursement policies.
  • Maintained up-to-date knowledge of third party payers' rules and regulations related to billing practices.
  • Performed daily audits of submitted claims to verify accuracy prior to submission.
  • Ensured compliance with HIPAA privacy regulations when handling sensitive patient information.
  • Resolved denied or rejected claims by submitting appeals to the appropriate payer.
  • Reviewed and processed medical claims for accuracy according to insurance guidelines.
  • Performed data entry into computerized systems used for tracking patient encounters, services rendered, charges billed.
  • Verified patient information, such as demographics and insurance coverage, to ensure accuracy of claim submissions.
  • Prepared reports of unpaid or rejected claims for management review.
  • Filed and submitted insurance claims.
  • Assessed medical codes on patient records for accuracy.
  • Documented and filed patient data and medical records.
  • Reviewed medical records to meet insurance company requirements.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Reviewed claims for coding accuracy.
  • Completed and submitted appeals for denied claims.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Submitted appeals using provider portals and phone communication.
  • Monitored past due accounts and pursued collections on outstanding invoices.
  • Trained new team members on company policies and accounting systems to keep team operations productive and efficient.

Answering Service Operator

Medical Communications
Oakland, CA
06.1998 - 04.2002
  • Assisted with training new employees on answering service procedures.
  • Performed data entry of customer information into the computer system.
  • Researched and resolved customer complaints quickly and efficiently.
  • Maintained call logs, records and other documents related to answering service operations.
  • Responded to customer inquiries in a timely manner.
  • Ensured all company policies were followed during calls.
  • Verified customer accounts by obtaining additional information as needed.
  • Routed calls to appropriate personnel or departments.
  • Entered notes into the database for each call received.
  • Maintained a professional attitude while handling difficult situations.
  • Answered incoming calls promptly and courteously.
  • Escalated customer complaints or issues to supervisor when necessary.
  • Maintained excellent customer satisfaction through polite, calm demeanor.
  • Researched and quickly resolved customer issues.
  • Transcribed and forwarded customer messages to professionals.
  • Answered calls with friendly and polite approach to engage callers and deliver exceptional customer service.
  • Operated telephone switchboard and routed calls to correct destination.

Education

Certification - Medical Insurance Billing & Coding

Bryman College
San Francisco, CA
12-2002

High School Diploma -

Dewey High School
Oakland, CA
06-1995

Skills

  • Supervision and leadership
  • Training & Development
  • Friendly, Positive Attitude
  • Data Management
  • Verbal Communication
  • Interpersonal Communication
  • Call Center Software Proficiency

Certification

  • Medical Insurance Billing & Coding Certificate

Timeline

Medical Insurance Biller

Womens' Choice Clinic
01.2003 - 03.2004

Telereceptionist

Directline Inc.
06.2002 - 09.2022

Answering Service Operator

Medical Communications
06.1998 - 04.2002

Certification - Medical Insurance Billing & Coding

Bryman College

High School Diploma -

Dewey High School

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Nicole Clemons