Salesforce
Susan Mack
Lead Insurance Verification Specialist
Saint Louis Park,MN
Summary
Personable and dedicated customer service representative with extensive experience in healthcare industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses. Respected as being people-oriented, productive, dependable and willing to help wherever the need arises. Recognized for being adaptable to a constant changing working environment.
Overview
36
36
years of professional experience
Work History
Lead Customer Quality Specialist-Insurance Re-verification
Coram Specialty Infusion
Minneapolis, MN
09.2009 - Current
- Experience with Medical Insurance Coverage (Commercial, Medicare, Medicaid, Liability) for Infusion Therapy, Home Health Care therapy.
- Utilized Terminology and Billing Codes to verify precise coverage for Infusion Therapy and Home Health Care based on patient's plan
- Reviewed and verified health insurance benefits for patients prior to their scheduled appointments.
- Advocated for patients by contacting insurance carriers and obtaining necessary benefits information.
- Interpreted complex policy language from insurance providers to determine benefits coverage.
- Conducted root cause analysis for identified problems related to benefits provided versus authorization and/or claims processing.
- Assist in training new BV Specialists, once they complete initial onboarding, to ensure their comprehension of processes and procedures.
- Provide feedback to individual BV Specialists on issues brought to my attention, as well as complete audits on reps to ensure accuracy in process procedures.
Cashier/Customer Service Representative
Cub Foods
Saint Louis Park, MN
01.2002 - 01.2010
- Provide friendly customer service and assist customers with returns, questions, problems, transferring money, and purchasing money orders.
- Accurately ring up customers' orders and process payment efficiently.
- Fill in as Front-End Customer Service Manager, as needed.
- Facilitated the orientation of new employees to ensure they are ready to do their assigned job.
- Answered customer inquiries regarding store policies and procedures.
Lead Medicare Billing Representative
Apria Healthcare
Minnetonka, MN
01.2006 - 01.2009
- Reviewed, edited, keyed, and submitted medical claims to Medicare for accurate payment.
- Facilitated timely billing of claims to Medicare within 48-hour goal
- Coordinated with various departments to expedite billing resolutions
- Adhered to all applicable laws, regulations, and standards pertaining to billing practices.
- Maintained adherence to industry standards for billing.
- Assisted in training new employees, ensuring compliance, and reviewing updates as they become available.
Quality Assurance Editor
BestMark, Inc.
Minnetonka, MN
01.2002 - 01.2006
- Reviewed and edited content for accuracy, clarity, consistency, and style.
- Contacted shoppers to gather further information, as needed.
- Developed detailed editing guidelines to ensure quality assurance standards were met.
- Conducted comprehensive reviews of documents for grammar, punctuation, spelling, formatting, and readability issues.
Accounting Clerk/Data Entry
Barrett Moving and Storage
Eden Prairie, MN
01.1998 - 01.2001
- Entered information correctly into computer program while checking for errors in Distribution; filed folders; scanned files; faxed requested information.
- Maintained up-to-date accounts receivable records and coordinated monthly billing activities.
- Processed invoices, payments, and statements in a timely manner.
Assistant to the Owners/Senior Server
Railroad House Restaurant Bed and Breakfast
Marietta, PA
01.1989 - 01.1998
- Supported business operations for owners
- Conducted comprehensive training for new servers to ensure exceptional dining experiences
- Coordinated bulk mail shipments effectively
- Organized and maintained filing systems for documents and records.
- Answered phone calls and returned phone messages
Education
High School Diploma -
Donegal High School
Mount Joy, PA06-1985
Skills
- Customer Service
- Team-Oriented Collaboration
- Expertise in Adobe Acrobat
- Billing Processes
- Corporate Ethics
- Accurate Call Documentation
- HIPAA Compliance Expertise
- Efficient Data Input
- Trustworthy Reliability
- Interpersonal Sensitivity
- EPIC System Proficiency
- Experienced with Microsoft Excel
- Experienced in Microsoft Teams Collaboration
- Proficient in Microsoft Word
- Effective Time Management
- Skilled in Outlook Express
- Clear Telephone Communication
- Regulatory Compliance
- Dependable Work Ethic
- Remote Work Readiness
- Salesforce Proficiency
- Training and coaching
References
References available upon request.
Work Preference
Work Type
Full TimeLocation Preference
RemoteImportant To Me
Work-life balanceFlexible work hoursHealthcare benefitsWork from home optionPaid time off401k matchPaid sick leaveWork Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Change is inevitable.
Growth is optional.
John C. Maxwell
Software
Epic
HomeCare 360
Timeline
Lead Customer Quality Specialist-Insurance Re-verification
Coram Specialty Infusion
09.2009 - Current
Lead Medicare Billing Representative
Apria Healthcare
01.2006 - 01.2009
Cashier/Customer Service Representative
Cub Foods
01.2002 - 01.2010
Quality Assurance Editor
BestMark, Inc.
01.2002 - 01.2006
Accounting Clerk/Data Entry
Barrett Moving and Storage
01.1998 - 01.2001
Assistant to the Owners/Senior Server
Railroad House Restaurant Bed and Breakfast
01.1989 - 01.1998
High School Diploma -
Donegal High School
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