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Joanna
904-520-8419
85081 Stephen Rd.
Yulee, FL 32097
Customer Service Representative
32 years experience W2
0
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Average rating
38
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Summary

Experience
Customer Service Representative
Oct 2003 - Jun 2018
Subject Matter Expert to Tier I and Tier II advocates offering training and assistance.
  • Proficient in Siebel, Diamond, Convergence, Quest, Availity, JIVA ARCHER, SAP P eople So ft and Microsoft Office products.
  • Providing excellent customer service in a high volume call center while maintaining quality, productivity and adherence.
  • Research ing and providing status on claim processing, payments, denials and adjustments in accordance with the member's benefit s.
  • Responsible for ensuring the provider's contract details are updated and fee schedules are accurate, all provider identification numbers are coordinated with National Provider Identification/Tax Identification numbers correctly and submitting all address changes for completion.
  • Responding to inquiries regarding benefits and eligibility for all lines of business.
  • Researching, reviewing and providing status of prior authorizations. Health Insurance Caseworker
  • Responsible for updating eligibility according to files received from the Healthcare Marketplace.
  • Calling the member for every case received from the Marketplace and keeping them informed of status.
  • Familiar with the different tiers of insurance provided by the government.
  • Responding to every case outlining all updates. Strategic Provider Advocate
  • Outbound Service Advocate for Strategic Provider Services. Responsible for assisting high volume providers reduce t heir outstanding balances.
  • Processing new claim entry and claim adjustments.
  • Reviewing aged appeals, returning invalid appeals, processing any authorization appeals and escalating all others.
  • Working with other Blue Plans either telephonically or through Blue Squared for all out of state inquiries.
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Patient Account Representative
Aug 1998 - Sep 2002
(TRC Staffing)
  • Work with multiple insurance carriers daily to resolve claims with open balances.
  • Review Florida Blue and Medicare accounts for accuracy after they were referred to the insurance department.
  • Review Florida Blue EOBs and submit additional information as needed.
  • Proficient in Powerchart, MRMS, Application Extender and PPP.
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Sales Support Specialist
Aug 1989 - Aug 1998
  • Paid commissions to brokers for healthcare policies.
  • Generated monthly reports to confirm paid premiums vs commissions distributed and mailed to agents.
  • Analyzed data from reports annually for audit purposes.
  • Entered and maintained small group health insurance policies. Processed renewals and adjusted rates for group policies.
  • Daily phone contact with internal and external customers.
  • Daily use of Microsoft Word, Excel and Access as well as e-mail.
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Eligibility Technician
Aug 1989 - Aug 1989
  • Validated and enrolled newborns in Medicaid.
  • Reconciled electronic files received from large and small groups with our billing and eligibility department.
  • Made policy changes as requested by members.
  • Maintained quality and productivity while answering inbound customer calls.
Medicaid
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Edit Skills
Non-cloudteam Skill
Education
Andrew Jackson Senior High 1989
Skills
Medical Records
2018
15
Medical Billing
2018
30
EMR
2018
25
Diamond
2018
23
Siebel
2018
23
Appeals
2018
15
Compliance
2018
15
CPT
2018
15
HCPCS
2018
15
JIVA
2018
15
Medicare
2018
15
Medical Coding
2018
5
Medical Claims
2018
15
Medicaid
1989
1