Customer Service Professional

Manage day-to-day operations for a team built of 10-25 FTEs
Created, managed, and revised SOPs upon client request
Hosted weekly/biweekly meets with operations and billing team for KPI updates
Evaluated revenue cycle processes and established actionable methods to increase productivity and efficiency by 35%
Complete escalated patient claims by consulting with insurance companies to ascertain pertinent information regarding policies and pay benefits for patients
Analyzed Payor response for action on appeals and denials
Evaluated payor adjustment in proprietary database(s) to ensure accuracy for patient and insurance responsibilities
Conduct interviews and managed applicant data through a proprietary software

Arranged documents for insurance claims
Assessed policy coverage and pulled contracts for review
Negotiated settlements for claims in accordance with dental and medical payor liabilities
Checked documentation for appropriate coding, catching errors, and making revisions
Performed careful reviews of applicant proof of prior coverage to ascertain compliance with eligibility criteria for economic assistance