MARCELLA MILLER
Memphis,TN
Summary
Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.
Overview
10
10
years of professional experience
Work History
SR, Customer Service Representative Remote
OptumRx
Costa Mesa, CA
10.2022 - Current
- Handle 40-50 inbound calls to identify member needs and provide appropriate support
- Refill medications, review/resolve rejected claims, confirm/update member demographics, and add payment method.
- Create new patient accounts when necessary
- Transfer calls to appropriate department and resolve caller inquiries using internal resources and escalate when needed.
- Document all interactions and resolutions accurately
- Monthly sentiment score average over 7.
- Developed solutions-oriented approaches when faced with challenging situations or dissatisfied customers.
Call Center Representative
Le Bonheur Children's Hospital
Memphis, TN
01.2022 - 11.2022
- Managed approximately 50 inbound and outbound calls to identify patient needs and provide appropriate support
- Schedule, reschedule, confirm, and cancel patient appointments
- Accurately enter and update patient information in the scheduling system
- Review and update patient demographics and consent forms
- Transfer calls or relay messages to facilities, physicians and / or nurses
- Resolve caller inquiries using internal resources and escalate when needed
- Document all interactions and resolutions accurately
- Maintain patient confidentiality in accordance with company policies and HIPAA regulations
Medical Billing Specialist
Physicians Data Services
Memphis, TN
01.2016 - 12.2021
- Processed medical claims accurately and efficiently using advanced billing software.
- Collaborated with healthcare providers to resolve coding discrepancies and enhance claim accuracy.
- Correctly coded and billed medical claims for various doctors and nurse practitioners.
- Reduced claim denials through meticulous verification of patient eligibility and coverage benefits prior to claim submission.
- Assisted patients with understanding their insurance coverage and financial responsibilities, fostering positive relationships and trust between the practice and its clients.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Processed and tracked requests for medical records from external organizations.
- Verified accuracy of accounts payable payments, resulting in 97% reduction in payment errors and check reissues.
Education
Associate of Applied Science - Business Management
Centura College
Virginia Beach, VA01-2010
Skills
- Medical Billing & Coding
- Microsoft Programs
- Spreadsheet & Database Creation
- Data Entry
- Accounts Payable/Receivable
- Call center experience
- Computer proficiency
- Insurance verification
- CMS-1500 form completion
- Medicare and Medicaid billing
- Appeals processing
- Denial management
- Medical terminology
- Insurance coding (ICD-9, ICD-10, Diagnostic Coding, and CPT)
- Training and mentoring
Timeline
SR, Customer Service Representative Remote
OptumRx
10.2022 - Current
Call Center Representative
Le Bonheur Children's Hospital
01.2022 - 11.2022
Medical Billing Specialist
Physicians Data Services
01.2016 - 12.2021
Associate of Applied Science - Business Management
Centura College