Rita Scholz
Appleton,WI
Summary
Dynamic professional with a proven track record in medical billing and customer service excellence, notably at Charles Taylor. Skilled in leveraging Microsoft Office and Citrix to enhance operational efficiency. Recognized for team leadership and fostering client relationships, consistently achieving and surpassing project goals. Expert in regulatory compliance and database administration, ensuring meticulous attention to detail and process improvement.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Medical Work Comp Bill Review Specialist
Charles Taylor
07.2022 - Current
- Using Strata Ware, Citrix, Excel, Teams, WeQ and other software systems
- Validating and data matching the information in the systems to the claims image
- Editing, entering and updating bill information
- Forwarding claim to proper department when needed
- Consistently continue CPT /ICD / codes education
- Import bills into Strata ware
- Run test bills for new clients
- (currently enrolled in TEXAS WORKERS COMPENSATION ADJUSTER courses to obtain license)
Account Manager claims
Humana
07.2021 - 07.2022
- Addresses customer needs which may include complex benefit questions, resolving issues, and educating members
- Records details of inquiries, comments or complaints, transactions or interactions and takes action in accordance to it
- Escalates unresolved and pending customer grievances
- Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology
- Works within broad guidelines with little oversight
- Providing access to coaching, resources, and development
- Point of contact for new hires current employees regarding compliance processes
- Update compliance records for new and current employees
- Update changes to personal information; such as address, phone, email
- Identify problems or issues of concern in the hiring of employees
- Propose changes in procedures and identify problem areas
- 2 years of HR, onboarding or Credentialing administration in high volume environment required
- Two years of responsible administrative experience required
- Ability to type at least 50 net words per minute
- Knowledge and ability to work with word processing, spreadsheets, and database systems
- Able to thrive in a fast-paced environment
- Able to manage multiple priorities and projects
- Must be able to use office equipment
- Must have ability to multitask
Claims editor, processor / auth matching
WPS Health Solutions
01.2020 - 07.2021
- Analyze claims to be determine if all claims filing requirements have been met
- Update line items to complete adjudication of claims
- Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations
- Maintain integrity of claim auditing system by identifying and reporting potential system problems
- Provide examples and documentation to support findings
- Deal tactfully with people in a wide variety of situations to convey a favorable corporate image
- Initiate written communication via web application letter writing system
- Keep with in daily/weekly/ monthly Stats
- Maintain a positive and professional attitude
- Work with members of staff on identifying process improvements
- Perform other duties as assigned by management
- Report to work on a consistent, regular basis during core business hours 6:00 A.M
- -12:00 A.M
- Facets
- Outlook
- OnBase
- Sky net
At Home Customer Service Representative
Adecco / PetSmart
10.2019 - 01.2020
- Work in a virtual environment assist with placing orders, store complaints
- Microsoft office
- Verint / blue pumpkin
- SABA
- VPN
- VDI
- Skype
- OKTA
Associate Customer Service Representative
Brooksource staffing
Appleton, WI
09.2019 - 10.2019
- Assist members with opening membership accounts
- Debit/ credit card credit and disputes
- Wire transfers
- Internal/ external transfer
- Online banking tech support balance inquiries
Provider Relations Representative
CYPRESS BENEFIT ADMINISTRATORS
Appleton, WI
02.2019 - 09.2019
- Provide responsive and professional customer service to providers regarding status of medical and dental claims
- Utilize necessary resources and navigate systems efficiently to accurately verify eligibility and provide verification of benefits
- Assist providers in getting set up and utilizing Provider Portal
- Maintain a positive and professional attitude
- Work with members of staff on identifying process improvements
- Perform other duties as assigned by management
- Report to work on a consistent, regular basis during core business hours (8:00 a.m
- - 5:00 p.m.)
Tier 1 Technical Chat / phone Support agent
Kelly Services
Appleton, WI
05.2016 - 02.2019
- Assist customers with technical issues with their devices
- Assist with Apple ID, iCloud and iTunes Store issues
- Met monthly goals and expectations
- Office Manager within 3 months of hire
- Permanent floorwalker to assist other advisors for both OS and iOS chats
- Performed initial client assessment and analysis to begin research process
- Researched and updated all required materials needed for firm and partners
- Provided base level IT support to non-technical personnel within the business
- Evaluated and responded to incoming sales leads and requests for technical support assistance
- Reviewed technical documentation and procedures
- Installed software, modified and repaired hardware and resolved technical issues
- Remained up-to-date on the latest technologies and solutions applicable to company products
- Identified and solved technical issues with a variety of diagnostic tools
- Defined and documented technical best practices
- Managed call flow and responded to technical support needs of customers
- Resolved problems with malfunctioning products
- Assisted customers with order placing
- Retained existing clients and developed new business by extending high quality and efficient service
- Appropriately documented all transactions and pertinent interactions
- Managed customers' expectations and experience to a high degree of customer satisfaction
- Maintained and updated customer service database
- Used ticketing systems to manage and process actions taken
- Provided on-call support for critical issues
- Demonstrated professionalism and courtesy with customers at all times
- Conducted research to address customer concerns
- Worked closely with team members to meet or exceed all customer service requirements
- Engaged users and answered questions on website and in forums
- Answered telephone calls promptly and minimized delays that could lead to abandoned calls
- Maintained high departmental standards for quality and productivity metrics
- Trained end-users in Office Manager to over 6 Pods, each with 20 Advisors
Card Services Representative
Kohl's Corporation
Menomonee Falls, WI
02.2014 - 09.2015
- Effectively managed a high-volume of inbound and outbound customer calls
- Answered a constant flow of customer calls with up to 30 calls in queue per minute
- Addressed and resolved customer product complaints empathetically and professionally
- Gathered and verified all required customer information for tracking purposes
- Developed all process controls and metrics for daily management of the Call Center
- Met or exceeded service and quality standards every review period
- Improved call center functionality and service capacity by resolving customer complaints efficiently and quickly
- Managed call center from initial start-up to full operational status
- Acted professionally and patiently when addressing negative customer feedback
- Analyzed call volume and average call time to monitor Customer Service Representative performance and productivity
- Prepared reports and communication for senior management and clients
- Resolved service, pricing and technical problems for customers by asking clear and specific questions
- Referred unresolved customer grievances to designated departments for further investigation
- Identified chronic customer issues by creating and maintaining customer complaint log
- Managed high call volume with tact and professionalism
- Conducted performance reviews for all Customer Service Representatives to reduce resolution time and improve customer satisfaction rates
- Oversaw call center employees to ensure customer satisfaction goals were consistently met
- Provided incentive to increase productivity by offering employees awards for best customer service
- Initiated operations improvements to improve overall call center productivity
Office Manager
Target Communications
Mequon, WI
12.2005 - 12.2013
- Office Manager/ Receptionist
- Held oversight of office inventory activities, including ordering and requisitions, stocking and shipment receiving
- Communicated corporate objectives across all divisions through regular correspondence and scheduled follow-up
- Established efficient workflow processes, monitored daily productivity and implemented modifications to improve overall effectiveness of office personnel and activities
- Established and developed highly-efficient and dependable administrative team by delivering ongoing coaching and motivation while providing opportunities for career acceleration through achievements
- Oversaw daily office operations for staff of 7 employees
- Managed executive calendar and coordinated weekly project team meetings
Education
certificate - TEXAS WORKERS COMPENSATION ADJUSTER
Insurance Schools INC
Remote, Texas01.2025
Associate - Medical Transcription
Penn Foster
Remote01.2013
High school diploma or GED -
Skills
- Team leadership
- Policy and procedure modification
- Relationship building
- Microsoft Office Specialist Certification
- Documentation and control
- Regulatory compliance
- Database administration
- Program management
- Deadline driven
- Apple Certified Technical Coordinator (ACTC)
- Apple Certified Desktop Technician (ACDT)
- Customer service expert
- Perfect Attendance Award
- Fast learner
- Analytical and critical thinker
- Skilled multi-tasker
- Talented client relations manager
- Multi-line phone operation proficiency
- Customer service award (10 years)
- Skilled in call center operations
- Strong problem solving aptitude
- Persuasive speaker
- Completed telephone training seminar
- Excellent communication skills
- Social media knowledge
- Advanced clerical knowledge
- Administrative support specialist
- Customer service-oriented
- Flexible
- Pleasant demeanor (5 years)
- Front Desk
- Service Desk
- Helpdesk Support
- Desktop Support
- Tech Support
- Help Desk
- Customer Service
- Customer Support
- Call Center
- MAC
- Linux
- Sales Experience
- Excel
- Office Experience
- Microsoft Word
- Microsoft Office
- Microsoft Office (10 years)
- Data Entry (10 years)
- Microsoft Outlook (10 years)
- Active Directory
- OKTA (6 years)
- Avaya (7 years)
- Blue pumpkin/ Verint
- Salesforce (3 years)
- VPN (6 years)
- Zendesk
- E-Commerce
- Typing
- Live Chat
- AWS
- Facets (Less than 1 year)
- Operating Systems
- LAN
- Microsoft Windows
- Network Support
- Documentation review
- Administrative experience
- Medical billing
- CPT coding
- ICD-10
- Medicare
- Military
- Analysis skills
- ICD-9
- HCPCS
- SharePoint
- Google Suite
- Citrix
- Medical terminology
- IVR
- Medical coding
- HIPAA
- Hospital experience
- EDI
- Employment & labor law
- Workday
- Workers' compensation law
- Live chat
- Windows
- Operating systems
- Customer service
- Help desk
- Desktop support
- VPN
Certification
- Driver's License, Active
- TX All Lines Adjuster License , Currently taking courses to obtain my adjuster license.
Personal Information
Work Permit: Authorized to work in the US for any employer
Assessments
- Call center customer service, Proficient, 06/21
- Customer service, Proficient, 01/20
- Customer focus & orientation, Proficient, 05/21
Timeline
Medical Work Comp Bill Review Specialist
Charles Taylor
07.2022 - Current
Account Manager claims
Humana
07.2021 - 07.2022
Claims editor, processor / auth matching
WPS Health Solutions
01.2020 - 07.2021
At Home Customer Service Representative
Adecco / PetSmart
10.2019 - 01.2020
Associate Customer Service Representative
Brooksource staffing
09.2019 - 10.2019
Provider Relations Representative
CYPRESS BENEFIT ADMINISTRATORS
02.2019 - 09.2019
Tier 1 Technical Chat / phone Support agent
Kelly Services
05.2016 - 02.2019
Card Services Representative
Kohl's Corporation
02.2014 - 09.2015
Office Manager
Target Communications
12.2005 - 12.2013
- Driver's License, Active
- TX All Lines Adjuster License , Currently taking courses to obtain my adjuster license.
certificate - TEXAS WORKERS COMPENSATION ADJUSTER
Insurance Schools INC
Associate - Medical Transcription
Penn Foster
High school diploma or GED -
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