Nikita Notise
Douglasville,GA
Summary
Dynamic professional seeking to leverage exceptional skills and talents in a forward-thinking organization. Proven ability to drive growth and enhance operational efficiency. Equipped with a strong background in strategic planning and team collaboration. Committed to contributing to the success of the company while pursuing continuous professional development.
Overview
10
10
years of professional experience
Work History
Customer Service Representative
Masa Global Planation
, USA
01.2017 - 01.2019
- Schedule non emergent transportation for Medicare & Medicaid patient
- Creating claim number for new claims received via mail, email & fax
- Putting all claims on new claim scan log
- Creating claim form for all ground and air claims
- Scanning all new claims into PTS(software) and creating folder for each new claim in pending
- Verifying balance on claims as they come in to be paid
- Answering phones as needed
- Sending out all denial letters for non-approved claims
- Sending out all paid in full letters on all paid claims
- Entering all paid checks into PTS and entering all paid checks into weekly claim log
- Entering all claims to be paid into PTS and putting on claim log weekly and moving claim folder to ready to be paid folder
- Delivering claims weekly to accounting for payment
- Following up with all claims in PTS to verify accounting numbers match PTS and weekly claim log
- Following up on claims to be paid in central pending
- Reduction- follow up as well (print copy of the letter approved/denied, update the excel sheet if the provider negotiated or not.)
- Steno calls & Check trace
Front Desk/ Customer Service Rep
Rand Eye Institute
Deerfield beach, USA
01.2017 - 12.2017
- Registers patients by gathering, verifying, and entering demographic and insurance information
- Prepares day’s sheet and balances for each day
- Handles inquiries about insurances accepted, office hours, services, exam fees, doctor information, etc
- Verifies upcoming appointments
- Handles telephone receptionist responsibilities
- Assists other service staff as needed
- Properly triages patients and visitors
- Responds easily to routine requests for information
- Maintains patient confidentiality at all times and communicates with the compliance officer regarding procedural changes and concerns
- Issues proper receipts and maintains balanced drawer
- Billing for the doctor’s office visit and pavilion-ambulatory surgery center
- Correcting claims, rejected claims, appeals
Customer Service Representative
Allied Health
Boca Raton, USA
01.2015 - 12.2017
- Receive inbound faxes from contracted Doctors’ offices of patient’s demographics
- Prepare and submit clean claims to various insurance companies electronically or via paper for diagnostics testing services conducted
- Work directly with the insurance company and healthcare provider to ensure claim is processed and paid
- Identify and resolve billing complaints
- Process payments from insurance companies and prepares a daily deposit via ERA, EFT, Patient Payment submitted via check and post to practice and patient account for payment, deductibles, allowed amount, coinsurance and any take backs per Health Insurance Remit Advice via Medisoft Software
- Establish and maintain effective and cooperative working relationships with insurance companies
- Upon submitting claims fix any rejected claims to submit to payer and or printing corrected claims to mail out to payers, following up on claim status with health insurance denials
- Balance and Reconcile Claims for anticipating daily total from insurance payers Printing reports of daily accounts totals
- Receive daily mail sort, file and scan mail into data base for patient records, electronic remittance, denial letters, worker’s compensation letters, lawyer offices, scan health insurance credentials packages and certifications into database mail out patient
Customer Service Representative
Univita Health
Miramar, USA
01.2011 - 01.2014
- Receiving inbound calls and making outbound calls to Home Health Agencies, Doctors offices, Pharmacies for claims status for DME items submitted on claims and Pharmacy IV claims
- Receiving inbound calls from providers needing assistance with claim status, claims via online portal education, reprocessing claims for pass timely filing period for appeals
- Determining Eligibility for members for claims pending payments (Medicare/Medicaid) or past paid claims to send out refund letters
- Billing forms on CMS 1500 and UB 04 Format for Medicaid and Medicare Patients
- Transitional Patients changing insurance
- Process claims from valid states as Original or Resubmits inputting correct ICD-9 and CPT codes, valid Authorization number to get paid claims in Adjudication status
- Receiving resubmission for claims for reprocessing, researching claims to not overpay and get short paid claims reprocessed in Adjudicated status and overriding claims and voiding claims
- Researching authorizations and delivery ticket amount for claim status information
- Calling providers regarding Explanation of Payment to get correct address on file
- Posting Payment to accurate accounts
- Prepares necessary state fillings within statutory limits
- Data Entry on Backdated claims
- Communicate claims activity and processing with the claimant and the client; maintains professional client relationships
- Ensures claim files are properly documented and claims coding is correct
- Handling corrected claims project to make sure provider gets paid accordingly owed amount
- Receive mail of claims and clinical notes scanning into the claims queue for original or resubmits
- Mailing back incorrect claims to providers due to patients not found
- Provide clerical and administrative support to staff for correct authorizations number to bill on claims
Customer Service Representative
Life Extension
01.2009 - 01.2011
- Reviewed and released pending customer orders
- Processed delegated claims per regulatory and contractual guidelines
- Handled inquiry on billing and payment requests
- Handle high-volume workload within a specified timeframe
- Work on projects as needed
- Monitored itemized billing for excessive charges, correct billing codes, Authorization, eligibility, audits, duplications, and determination and prior
Education
High School -
Farrockaway Highschool
Queens, NYMedical Laboratory Technician -
Keiser University
Ft. Lauderdale, FlSkills
- Microsoft Word
- Excel
- Outlook
- Data Entry
- Type 45 WPM
- Telephone
- Fax machines
- Copy and Printer Machines
- Effective oral and written communication skills
- Able to use more than one program at once
References
Available upon request
Timeline
Customer Service Representative
Masa Global Planation
01.2017 - 01.2019
Front Desk/ Customer Service Rep
Rand Eye Institute
01.2017 - 12.2017
Customer Service Representative
Allied Health
01.2015 - 12.2017
Customer Service Representative
Univita Health
01.2011 - 01.2014
Customer Service Representative
Life Extension
01.2009 - 01.2011
High School -
Farrockaway Highschool
Medical Laboratory Technician -
Keiser University
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