ROBERT LING III
Willingboro,NJ
Summary
Healthcare professional with extensive experience in managing patient accounts and ensuring seamless billing processes. Known for strong focus on team collaboration and achieving results, consistently adapting to changing needs. Skilled in financial record-keeping, claim processing, and patient communication, offering reliability and dedication to excellence.
Overview
19
19
years of professional experience
Work History
PATIENT ACCOUNT REPRESENTATIVE - FOLLOW UP
Cooper University Hospital
03.2024 - Current
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Effectively follow-up on outstanding charges via payer web portals, phone and other computerized methods.
- Working through insurance denials and rejection of claims with insurance companies as well as DRG Denial.
- Obtain medical records to provide supporting documentation as needed for claim processing and Appeals.
- Posted payments and processed refunds and adjustments.
- Communicate status of resolution efforts.
Senior Customer Experience Rep
AmeriHealth Administrators
05.2016 - 08.2023
- Effectively managed a high-volume of inbound and outbound escalated calls, customer e-mails, customer service chat
- Resolved benefits, pricing, and technical issue for customers by effective listening and asking probing questions
- Gathered and verified all required customer information for tracking purposes
- Addressed and resolved customer product issues aggressively and professionally
- Maintain professional demeanor when addressing unfavorable customer feedback
- Accurately documented, researched and resolved all escalated customer service issues
- Worked alongside manager to oversee day-to-day operation
- Monitor team performance and report on metrics
- Identify trends, assist with live call monitoring and chair-side coaching and give ongoing feedback, discover training needs and provide coaching on work procedures, and proper call handling, assist with team member question in team group chat
- Meet with manger weekly to go over individual and team performance on a regular basis and provide candid and timely feedback regarding developmental and training needs; includes completion of monthly and annual scorecards
- Assist with monitoring all performance measures such as daily stats and schedule adherence
Medical Claims Resolution Specialist II
Horizon Blue Cross Blue Shield NJ
11.2005 - 05.2013
- Daily review of other claims specialists work to ensure completeness, accuracy, and compliance within established standards of quality
- Examined claims forms and other records to determine insurance coverage of claimant inquiries
- Verified the validity of claims by obtaining specific data from physicians' statements
- Streamlined communication with clients and healthcare providers via correspondence and electronic devices
- Determined the extent of a company's liability, consistent with policy provisions, standard medical practice for specific treatments interventions, and National Medicare & Medicaid Statutes
- Prepared monthly reports of findings and processed medical insurance claims, exercising authority to approve or reject settlements based upon established criteria
Education
Business Management -
University of Scranton
Skills
- Leadership experience
- Personnel management & deployment
- Excellent time management skills
- Exceptional interpersonal communication
- Advanced clerical knowledge
- Microsoft Suite
- Microsoft Teams
- Salesforce
- NICE IEX (WFM)
Timeline
PATIENT ACCOUNT REPRESENTATIVE - FOLLOW UP
Cooper University Hospital
03.2024 - Current
Senior Customer Experience Rep
AmeriHealth Administrators
05.2016 - 08.2023
Medical Claims Resolution Specialist II
Horizon Blue Cross Blue Shield NJ
11.2005 - 05.2013
Business Management -
University of Scranton
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