HIGHLIGHT OF QUALIFICATIONS

* Excellent team player, able to deliver results under pressure.
* Exceptional organizational, analytical, and influencing skills.               
      
* Able to create and preserve positive professional working relationships with
multiple clients and customers.
* Previous maintained a successful work at home environment. 
* 13 years of experience in ICD-9 codes, CPT codes and medical terminology.
* Knowledgeable in Medical Manager, Internet, EDS, WordPerfect, Poorman
Douglas,Clientele, Clinical Logic, Oracle, and Microsoft Word and Excel.
* Consistently high work quality, production level, and problem solving
capabilities.
* Strong customer/member/client relation skills with over 17 years of
experience.
* HIPAA trained and certified.


WORK HISTORY AND LIST OF SERVIVES PROVIDED
                                          
NPPN: National Preferred Provider Network
Client Support/Claim Service Representative
5/01-4/08 
* Continually performed 100% quality and resolved the highest number of appeals
in department (approximately 20% of all appeals). 
* Established a successful work at home environment.
* Chosen to represent department for many trouble shooting discussion meetings
with departmental heads and the vice presidents of the company. 
* Contacted providers with disputes, and successfully negotiated appeals.
* Corresponded directly with TPA’s regarding claim, provider, and network
issues.
* Met and exceeded the expectations of one of the company’s largest accounts.   

* Made educational calls explaining PPO network affiliates, procedures and
policies.
* Discussed and reviewed client and provider contracts. 
* Point of contact for specific sub-networks, handling contacts and network
issues.
* Generated professional correspondence on a daily basis for clients, patients,
doctors, department, and satellite offices.
* Developed reports on each insurance company including open issues, and current
statistics.
* Created the SOP’s (Standard Operation Procedures) for multiple departments.
* Provided members/clients with PCP and specialist information, and discount
claim status.
* Accurately handled 97 clients’ accounts and multiple sub-account appeals
within the required turnaround time and guidelines set by each individual
client.

Metropolitan Cardiology
Medical Secretary
2/00- 5/01
Dr. Javdan’s Medical P.C.
Medical Secretary
2/98- 2/00
* Interacted with insurance Companies for Pre-certification of patient
procedures. 
* Scheduled and confirmed appointments and procedures.
* Contacted hospitals to schedule patient for hospital procedures.
* Inquired on claim status for multiple insurance companies.
* Solved aged and denied claim issues for payment.
* Met with various insurance companies to trouble shoot issues.
* Input patient information, charges, reports, billing, referrals and
consultation letters.


Empire BC/BS
Clerical Staff Member
12/90- 5/96
* Established and organized a microfilm department.
* Supervised department Staff as back up for team senior.
* Knowledgeable of medical billing and insurance company procedures.
* Formulated different insurance company/department criteria.
* Exceeded required production level consecutively for 6 year (110% and 150%
daily).
* Created individual microfilm accounts for a wide range of miscellaneous
insurance companies.


Caldor
Customer Service Rep/Head Cashier
11/94- 10/99
* Supervised division’s cashiers.
* Organized and distributed employee work projects.
* Provided various customer service and customer inquiries.
* Secured nightly register receipts and logged each registers nightly earnings.


New York Opinion Center
Market Research Survey Rep
6/88- 12/90
* Questioned consumers on their experiences with various products.
* Created and filed reports on findings.
* Assisted in the running of the front desk.
 

EDUCATION
Valley Central High School
Montgomery NY 12549