Pamela Wiggins-Highsmith
71 Haverhill Pl, Somerset,NJ
Summary
To utilize skills developed through work experience and educational background in the field of healthcare support. Over 15 years of healthcare experience, which encompasses Insurance claims review; adjudicating and examining claims for payment or rejection; providing superior customer service to patients and healthcare providers; highly knowledgeable in managed care and third-party reimbursement as well as experience using ICD9/10; Mentor fellow representatives regarding company practices and more.
Overview
21
21
years of professional experience
Work History
Care Advisor
United Healthcare
02.2023 - Current
- Consulting directly with family members to listen, explore and understand their family members’ needs and being compassionate, empathetic, intuitive, and analytical process.
- Understand and learn about aging process and Home Care options and become trusted expert in developing care solutions for our clients based upon each Company’s offerings!
- Propose, offer, and explain each phone range price as well as to point out creative caregiver solutions based on our broad range of offerings.
- Communicate, support, and assist family members by providing solutions both orally and in writing
- Advise families during their decision-making process to help them select which best fits there caregiving solutions based on our system.
- Manage our care solution program from beginning to end by providing exceptional client experience.
Sr. Customer Service Advocate/ Remote
United Healthcare
07.2021 - Current
- Responsible for incoming calls within pertaining to questions from members/patient, providers with inquiries about their benefits/claims
- Also educate members how to use digital system such as, website to view plan benefits, claims and more.
Benefits Associate
Aflac
06.2020 - 03.2021
- Responsible for providing advice, conducting intermediary services between each client and Insurance Company, and selling life policies which pay out when life insured person dies.
Licensed Agent
Massmutual
02.2020 - 08.2020
- Responsible for providing advice, conducting intermediary services between each client and Insurance Company, and selling life policies which pay out when life insured person dies.
Licensed NJ Producer Agent (Life)
American Income
05.2019 - 01.2020
- Responsible for providing advice, conducting intermediary services between each client and Insurance Company, and selling life policies which pay out when life insured person dies.
Denial Follow-Up Rep
Aergo Solutions
08.2018 - 03.2019
- Initiating collection follow-on unpaid or denied claims
- Researching, appealing, and resolving insurance claims
- Following-up and collecting on electronic claims
- Correcting billing errors
- Responding to correspondence from insurance carriers
- Responding to patient billing inquiries.
Patient Account Representative
Carrier Clinic
06.2015 - 01.2018
- Organizes inpatient- outpatient claims for electronic or hard copy mail delivery
- Follow-up on outstanding aged accounts and apply appropriate adjustments; answer inquiries, updates accounts and refile claims and appeals as necessary
- Pre-Authorization- Benefit Verification; patient complaints and more
Reimbursement Specialist
Mckesson
08.2014 - 05.2015
- Process insurance claim denials, file appeals, and contact insurance companies
- Research, resolve, resubmit, or appeal all suspended or denied claims in timely manner.
- Review and audit aging A/R reports as necessary
- Meeting daily, monthly, and quarterly billing metrics
- Follow up with patients and third-party payers for payments
- Verify receipt of all patient registration data from client and notifying client of potential coding problems.
Customer Service / Call Center Representative
JFK Medical Center
07.2012 - 07.2014
- Responsible for incoming and follow up calls within our call center pertaining to patients, providers and other healthcare facilities and insurance inquiries
- Handled all incoming mail as well as scan and post payments
- Performed all front desk operation tasks related to billing/statements of patient’s questions and payments
- Performed all related refund tasks and other customer service duties and more.
Customer Service / Call Center Representative
Qualicare
11.2005 - 01.2011
- Responsible for incoming and follow up calls within call center pertaining to members/patient, providers and healthcare facility inquires; handled all incoming mail.
- Negotiated payments based on fee schedule and guidelines; evaluated and negotiated insurance denial disputes and claims processing.
- Knowledge of fair debt collection act, HIPPA Compliance and Medicare & Medicaid guidelines.
Medical Collection and Customer Service
Office Team
02.2003 - 08.2005
- Managed multi-specialty accounts, payment, and charge entry postings
- Performed all tasks related to medical billing and collections
- Assigned to charity care office and helped patient with their charity care applications
- Claims submission via mail, fax, or electronic filing
- Provided assistance for follow up calls regarding claim status and any provider issues.
Education
High School Diploma -
New Brunswick Senior High
New Brunswick, NJBachelor of Science - Healthcare Management
Virginia College
Birmingham, AL09.2024
Certificate - Medical Billing & Coding
Ashworth College
Norcross, GA06.2024
Skills
- Microsoft Word, Excel, PowerPoint, Outlook, Texen, AS 400, Medisoft, Medical Manager; Meditech, Uniflow, Texan, Health Solutions Plus (HSP), Optimum, E-Clinical, Escort and Epic Some other skills that are useful would consist of proprietary systems/databases, accurate data entry, and more
Salary
open
References
Available upon request
Timeline
Care Advisor
United Healthcare
02.2023 - Current
Sr. Customer Service Advocate/ Remote
United Healthcare
07.2021 - Current
Benefits Associate
Aflac
06.2020 - 03.2021
Licensed Agent
Massmutual
02.2020 - 08.2020
Licensed NJ Producer Agent (Life)
American Income
05.2019 - 01.2020
Denial Follow-Up Rep
Aergo Solutions
08.2018 - 03.2019
Patient Account Representative
Carrier Clinic
06.2015 - 01.2018
Reimbursement Specialist
Mckesson
08.2014 - 05.2015
Customer Service / Call Center Representative
JFK Medical Center
07.2012 - 07.2014
Customer Service / Call Center Representative
Qualicare
11.2005 - 01.2011
Medical Collection and Customer Service
Office Team
02.2003 - 08.2005
High School Diploma -
New Brunswick Senior High
Bachelor of Science - Healthcare Management
Virginia College
Certificate - Medical Billing & Coding
Ashworth College
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