Resolution Representative Resume Samples

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K Becker

Kane

Becker

56046 Crona Tunnel

Houston

+1 (555) 383 9566

56046 Crona Tunnel

Houston

Phone

p +1 (555) 383 9566

Experience Experience

New York, NY

Credit Resolution Representative

New York, NY

Simonis-Williamson

New York, NY

Credit Resolution Representative

Make posting corrections as necessary
Reports on root causes of Credit Balances to management
Performs refund and credit analysis, audit and reimbursement functions for all patient credit balance accounts
Other duties as assigned by Management
Other duties as assigned by Management 5%
Reports on root causes of Credit Balances to management 5%
Performs refund and credit analysis, audit and reimbursement functions for all patient credit balance accounts 60%

Houston, TX

Account Resolution Representative

Houston, TX

Kautzer, Beer and Wilkinson

Houston, TX

Account Resolution Representative

Respond to customer questions and complaints to ensure customer satisfaction and prevent delinquencies
Provide training and support to Contact Center Agents
Review and approve all adjustment forms including deferrals. The Account Resolution Team Specialist processes deferrals for the Collections Team to help reduce delinquency throughout the month
Will assist Supervisor in managing service levels
Will assist Research with processing interoffice correspondence and customer email
Support Contact Center by maintaining all past due accounts in the Collections work flow tool by monitoring the delinquency of the account and ensuring the accounts are in the correct work state
Support Sales by reviewing accounts that qualify for Owner Transfer Program and assist customers with questions

present

New York, NY

Inquiry Resolution Representative

New York, NY

Jenkins-Rippin

present

New York, NY

Inquiry Resolution Representative

present

Handling of disputes received via Billing Inbox
Account explanation
Analyze each specific dispute to determine what the resolution of such dispute should be. Process to include all necessary research in order to make proper determination for resolution of dispute
Back up to field calls from Tenet’s toll free line on consumer credit profiles answering questions and complaints pertaining to the facility’s soft inquiry, Central Financial Control’s hard inquiry and/or Central Financial Control’s derogatory reporting onto a consumer’s credit profile
Work with management and/or Perot systems to resolve any system/process issues identified through investigation process; including opening any necessary tickets with Perot systems for resolution of such issues identified
Investigate and resolve all claims of identity theft and/or theft of services regardless of LOB by working with consumer, consumer’s representative (i.e. attorney), facility, credit reporting agencies (CRAs), and/or police/sheriff’s department
Fair Debt Collection Practices Act (FDCPA)

Education Education

Bachelor’s Degree in Creativity

University of Florida

Bachelor’s Degree in Creativity

Skills Skills

Basic knowledge of CPT and ICD-codes
Basic knowledge of FDCPA
Basic Knowledge of UB-92 and Explanation of Benefits (EOB) interpretation
Knowledge of basic medical coding and third-party operating procedures and practices
Ability to operate a computer and basic office equipment
Ability to work with a team setting and be supportive of the team members
Ability to read, understand and follow oral and written instructions
Ability to establish and maintain effective working relationships with patients, employees and the public
Knowledge of business office procedures
Knowledge of computer programs

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13 Resolution Representative resume templates

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Claims Resolution Representative Resume Examples & Samples

Participates productively as member of team, possibly in a team lead role
Completes complex tasks, assignments and defined processes with some level of independence
Multiple assignments worked and completed simultaneously as directed by leadership
Identifies, prioritizes and resolves most questions and issues independently. Answers questions of peers. Escalates more complex questions or issues appropriately
Complies with contract requirements, business unit rules and related industry and legal regulations
High School Diploma or equivalent; may hold 2 year post-high school Degree; may hold Bachelor’s degree
A minimum of 2 years of working experience in related fields
Office administrative experience and skills
Must be available to work on-site in Madison, WI
Healthcare claims experience preferred
WI Medicaid experience preferred
Intermediate skills with Microsoft Excel
Ability to follow written policies, procedures and guidelines, and give feedback to leadership
Intermediate-level knowledge of operating systems
Self-motivated with good time management and organizational skills
Excellent written and verbal communication skills and customer service skills

Resolution Representative Resume Examples & Samples

Provides consistent service within established benchmarks contributing to achievement of business Client Service Commitments (CSC’s)
Proactively identifies and recommends solutions to recurring errors and service gaps; acts as a referral point/Subject Matter Expert for sales and service employees
Takes ownership and accountability for the resolution of issues and concerns at the first point of contact; demonstrating a long-term perspective in addressing client concerns
Identifies service/operational inefficiencies and makes recommendations for value added enhancements to appropriate parties
Supports revenue growth by reducing revenue leakage and focusing on other opportunity spotting initiatives

Account Resolution Representative Resume Examples & Samples

Monitor and respond to back office email communications
Monitor and action work as assigned through the Automatic Work Distributor(AWD) system
Build and maintain key operational day to day relationships to ensure operational efficiencies
Identify training requirements and build/recommend programs, where applicable, to address deficiencies
Maintain effective working relationships with internal as well as external customers
Assist in the oversight of external outsourcing relationship processes and provide feedback, and suggestions for improvement if necessary, within SLGI
Handle internal and external inquiries and refer escalated issues to Team Lead or Manager, as appropriate
Assist with day to day operational tasks relating to reporting, reconciliations (i.e. auditable tasks), web support, user access controls, etc
Assist with the support of dealer relationships and support of the dealer's back office needs
Contribute to continuous process improvement by recommending well-thought out changes
Act as information specialist and participate in projects as required
University degree or College diploma
Client Service experience is required
2+ years in the mutual fund and/or segregated fund industry
Experience within a Mutual Fund and/or Segregated Fund call centre and operational support
Operations or Canadian Securities Course (license) required. Candidates who are working toward either designation may be considered
Experience with the distribution network and various operating systems used within the mutual fund industry

Account Resolution Representative Resume Examples & Samples

Performing various collection actions including; contact with insurance companies and patients by phone
Reviewing zero pays to determine proper handling
Correcting and resubmitting claims to various carriers if applicable
Providing requested information to carriers to complete claim processing
Answering questions from patients, clerical staff and insurance companies
Identifying and resolving patient billing complaints
Preparing and reviewing accounts for payments made to patients
Following protocol for notification to patients for payments made directly to them
Following and reporting status of delinquent accounts
Allowing time each day to work clearinghouse rejected dashboard
Participating in educational activities and attends staff meetings
Conducting self in accordance with Alere's employee manual
Maintaining strictest confidentiality; adheres to all HIPAA guidelines/regulations
Knowledge of medical billing/collection practices
Knowledge of computer programs
Knowledge of business office procedures
Knowledge of basic medical coding and third-party operating procedures and practices
Ability to operate a computer and basic office equipment
Skill in answering a telephone in a pleasant and helpful manner
Ability to read, understand and follow oral and written instructions
Ability to establish and maintain effective working relationships with patients, employees and the public
Must be well organized and detail-oriented

Inquiry Resolution Representative Resume Examples & Samples

Strong decision making skills
Ability to exercise sound judgment and common sense in resolving all issues presented in dispute as well as issued identified during investigation
Ability to act independently as well as seek guidance when unsure as to how to handle a dispute, especially when with the ability to identify the different between interpretation of the law and excising solid judgment
Excels in Interpersonal, written, and verbal communication skills
Thorough understanding of all federal and state laws and regulations, such as, HIPAA, FDCPA, FCRA, and EMTALA but not limited to
Must be able to lift at least 10 pounds
MS Office proficient
College degree , however, not required
Minimum of 4 years of healthcare industry (preferable facility/provider) experience

Credit Resolution Representative Resume Examples & Samples

Responsible for the review, preparation and submission of the Credit Balances Quarterly Report
Responsible for follow up on credit balance accounts
Responds to patient inquiries and Insurance phone calls regarding account balances and refunds
Handle correspondence received from payors requesting refunds
Interacts with facilities to resolve accounts
Intermediate understanding of Microsoft Office
Intermediate oral and written skills, required
AA degree, preferred
Ability to sit and work at a computer terminal for long periods of time
Cheerful, pleasant, well ventilated, call center environment with multiple work stations in close proximity

Credit Resolution Representative Resume Examples & Samples

Performs refund and credit analysis, audit and reimbursement functions for all patient credit balance accounts
Reports on root causes of Credit Balances to management
3-5 years’ in a Hospital Patient Financial Services department
Call center environment with multiple work stations in close proximity

Inquiry Resolution Representative Resume Examples & Samples

Disputes escalated to Tenet executives, Legal, and/or National Ethics Compliance Line
Handling of disputes received via Billing Inbox
Work directly with patients, attorneys, government agencies, consumer protection groups, facilities (Admitting Manager, Director of Patient Services, Hospital Compliance Officer, Risk Manager, HIM Director, etc.), PFS Client Services Directors, Compliance, Security, Operations, Tenet Executive offices, and credit reporting agencies (CRAs) to resolve and respond to disputed issues in writing
Analyze each specific dispute to determine what the resolution of such dispute should be. Process to include all necessary research in order to make proper determination for resolution of dispute
Back up to field calls from Tenet’s toll free line on consumer credit profiles answering questions and complaints pertaining to the facility’s soft inquiry, Central Financial Control’s hard inquiry and/or Central Financial Control’s derogatory reporting onto a consumer’s credit profile
Work with management and/or Perot systems to resolve any system/process issues identified through investigation process; including opening any necessary tickets with Perot systems for resolution of such issues identified
Investigate and resolve all claims of identity theft and/or theft of services regardless of LOB by working with consumer, consumer’s representative (i.e. attorney), facility, credit reporting agencies (CRAs), and/or police/sheriff’s department
Thorough understanding of all federal and state laws and regulations, including but limited to HIPAA, FDCPA, FCRA, and EMTALA
College degree preferred

Open House Claims Resolution Representative Resume Examples & Samples

Arranges and reschedules appraisals, reviews appraisal reports and communicates with customers, and repair shops, etc
Secures essential facts about accidents, negotiates settlements and explains denials to policyholders. Identifies exceptions and transfers high complexity claim files as needed
Special assignments or projects as assigned
Responsible for developing proficiency and capabilities expected of a Low Complexity Representative during new hire ramp-up period
Position requires excellent oral, written, interpersonal communication and keyboarding skills along with the capacity to multi-task in a structured work environment

No Fault Customer Claims Resolution Representative Resume Examples & Samples

Obtains information about accidents and injuries from customers and claimants through telephone and written reports. Reviews medical records, researches claimed medical treatment, and communicates with customers, claimants, physicians, medical providers, attorneys, and repair shops, etc. Must secure medical record necessary to process claim
Secures the essential facts about accidents, assesses liability/compensability, negotiates settlements and explains denials to policyholders and claimants. Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Centralized Subrogation Unit
Uses internet and Liberty Mutual contracted vendors i.e.Smart Advisor, AIS) for evaluation of medical payments and treatment. Consults with Nursing staff or Medical Doctors for validation of information as required
Follows ICP procedures to screen and rule out bodily injury claims and refers potential bodily injury. Obtains recorded interviews as required
Processes Wage Claims, No-Fault and medical payment claims. Secures and reviews appropriate medical documentation to verify treatment and causal relationship
Arranges Independent Medical Exams as required
Assists in the training, coaching and counseling of Claims Representatives
Demonstrates a proficient understanding and use of the basic policy/contract coverages and is able to recognize questionable coverage/contract situations which necessitate supervisory involvement. Strong working knowledge of the various operations with the Claims Department and the ability to handle the complete claims representative work system is required
Ability to understand medical records and determine causality and medical necessity
The capabilities, skills and knowledge required is normally acquired through an Associate’s degree or equivalent experience and at least 1-2 years’ experience as a Claims Representative, NF or 5-7 years of directly related experience

Account Resolution Representative Resume Examples & Samples

Take escalated calls from owners, as well as help calls from agents located in the Las Vegas and Orlando Contact Centers. The help calls consist of calls from internal Contact Center Agents regarding questions on policies, procedures and other escalated questions that they are not able to resolve without assistance
Respond to customer questions and complaints to ensure customer satisfaction and prevent delinquencies
Respond to internal customer needs via Collections Help Desk Inbox. The Collections Management Team uses the Collections Help Desk Inbox to send escalated owner issues that need immediate attention from an experienced Agent. The Account Resolution Team Specialist responds to the email within an hour and will contact the customer within 1 business day
Provide training and support to Contact Center Agents
Review and approve all adjustment forms including deferrals. The Account Resolution Team Specialist processes deferrals for the Collections Team to help reduce delinquency throughout the month
Will assist Supervisor in managing service levels
Will assist Research with processing interoffice correspondence and customer email
Support Contact Center by maintaining all past due accounts in the Collections work flow tool by monitoring the delinquency of the account and ensuring the accounts are in the correct work state
Support Sales by reviewing accounts that qualify for Owner Transfer Program and assist customers with questions
Three years customer service experience in a call center environment
Advanced understanding of WVR and WbW product knowledge, standard operating procedures, policies and procedures
Must possess good time management and organizational skills
Ability to support supervisor in motivating, developing and coaching Contact Center Agents
Must exhibit problem-solving skills to resolve member concerns
Must display ability to train employees
Must exhibit professional communication skills both written and oral
Must possess basic math skills (85% score or better on Kenaxa Tests provided by Human Resources)
Some college
Financial experience
Ability to defuse escalated issues
Six Sigma Process Excellence skills
Work efficiently in a changing and dynamic environment

No Fault Customer Claims Resolution Representative Resume Examples & Samples

Obtains information and maintains accurate records about accidents and injuries from customers and claimants through telephone and written reports. Reviews medical records, and communicates with customers, claimants, physicians, medical providers, attorneys, agents and repair shops, etc
Secures essential facts about accidents, assesses liability/compensability, negotiates settlements and explains denials to policyholders and claimants. Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Centralized Subrogation Unit
Registers claims, updates status notes, establishes target dates, communicates with others, schedules appointments and releases payments on the automated system within limit of authority
May arrange Independent Medical Exams
The capabilities, skills and knowledge required is normally acquired through a High School diploma or equivalent experience and at least 1-3 years of directly related experience

Credit Resolution Representative Resume Examples & Samples

Responsible for all aspects of follow up and collections, including making telephone calls, accessing payer websites
Identify issues or trending and provide suggestions for resolution
Accurately and thoroughly documents the pertinent collection activity performed
Review the account information and necessary system applications to determine the next appropriate work activity
Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed
Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers
Edit claims to meet and satisfy billing compliance guidelines for electronic submission
Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory
Participate and attend meetings, training seminars and in-services to develop job knowledge
Participate in the monthly, quarterly and annual performance evaluation process with their Supervisor
Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system or escalated account issues
Intermediate technical skills including PC and MS Outlook
Intermediate knowledge of UB-04 and Explanation of Benefits (EOB) interpretation
Intermediate knowledge of CPT and ICD-9 codes
0-4 years’ experience in Medical/Hospital Insurance related collections

Claims Resolution Representative Resume Examples & Samples

Can you describe the best customer service experience you have ever had?
Can you define the worst customer service experience you have ever had?
Could you be committed to making a difference in a customer service experience?
Takes ownership of claims and drives claim closure/resolution
Identifies and takes appropriate action/process to allow for sound, timely and cost effective claim closure
Answers incoming calls, emails and voicemails from customers, contractors and escalated calls in a timely manner and according to guidelines
Handle aged warranty claims and expedite to close
Makes decisions and authorize work orders up to $300.00
Purchase necessary parts and equipment within a specified limit and skill set/trained
Obtains any necessary documentation form the customer and/or technician and attaches to the contract
Provides assistance with inbound call volume as needed
Performs all tasks in accordance to our performance/methods and procedure, quality assurance and compliance guidelines
Home Warranty or real estate experience desirable* Strong problem solving and conflict resolution skills
Able to decipher customer meaning (what customer really wants when they complain)
Ability to overcome objections
High stress tolerance
Analytical and detail oriented
Interest and aptitude to learn technical aspects of home operating systems and appliances

Account Resolution Representative Resume Examples & Samples

Performs various collection actions including; contact with insurance companies and patients by phone
Reviews zero pays to determine proper handling
Provides requested information to carriers to complete claim processing
Answers questions from patients, clerical staff and insurance companies
Identifies and resolves patient billing complaints
Prepares and reviews accounts for payments made to patients
Follows protocol for notification to patients for payments made directly to them
Follows and reports status of delinquent accounts
Allots time each day to work clearinghouse rejected dashboard
Participates in educational activities and attends staff meetings
Conducts self in accordance with Avee’s employee manual
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations

Lead Claims Resolution Representative Resume Examples & Samples

Advanced understanding of Home warranty polices and technical expertise with appliances
Excellent verbal, listening and written communication
Ability to multitask in order to meet critical deadlines
Ability to understand and execute policy and procedures
Demonstrated successful track record of participation in completion of projects, both short term and longer term
Emerging leader skills
Demonstrated success of establishing, and maintaining effective working relationships at the work group level
Fluent bilingual Spanish A plus
Ability to multitask in order to meet critica
Typically has 4-6 year’s Customer Service experience in a call center environment with 1-2 years of Lead experience

Claims Resolution Representative Resume Examples & Samples

Provides positive customer experience while appropriately handling routine auto claims by obtaining information and maintaining accurate records about accidents from customers through telephone and written reports. Champions our multiple electronic platforms
Reviews pending claims, updates claims file, executes on outstanding items, and moves files to closure expediently. Ensures payments processed timely as needed or inputs payments within authority
May be required to assist in CAT situations
Must demonstrate strong customer service focus, a proficient understanding and use of basic policy/contract coverage (including regulatory/policy differences, legal liability, and general policy coverage) and be able to recognize questionable coverage/contract situations which necessitate supervisory involvement
Requires strong working knowledge and ability to utilize multiple systems to handle/process claims
General understanding of overall claim operations and key stakeholders
High school diploma plus 1-3 years of related customer service experience or applicable insurance knowledge

Lead Account Resolution Representative Resume Examples & Samples

Effective verbal and interpersonal skills
Basic Knowledge of UB-92 and Explanation of Benefits (EOB) interpretation
Understanding HIPAA/ regulations

Customer Resolution Representative Resume Examples & Samples

Customer Care Representative must be able to manage large amounts of incoming calls because they will be the primary point of Contact for our residential and retail customers who contact our Call Center by phone or email, through the customer care lines of business
The individual must be able to identify and asses the customer’s needs to achieve satisfaction
Must be an excellent problem solver who can handle complaints, and is able to provide appropriate solutions and some alternatives within a time frame for a resolution
Being able to sustain relationship of trust through open and interactive communications with our customers and with fellow colleagues
The Individual must be able to take the extra mile to engage with our customers
Individual must have sales skills and must have the ability to effectively multi-task with daily tasks
Will be responsible for managing different tasks as customer’s input online request, scheduling a time of service, processing billing payments, open & closing service request
Must be able to collect payments for contracts that have an outstanding balance, following up callbacks with the customers to ensure they have been scheduled with a 3rd party vendor for service
Checking voicemails for all business such as residential and retail
Agents are trained on and utilize multiple applications such as Salesforce and Dispatch Console for scheduling
Knowledgeable in call routing and case management processes as well as case logging
Understanding internal processes and tools
2+ years of experience working directly with customers
1-2 years in a call center environment preferred, but not required
Bilingual in English and Spanish a plus, but not a requirement
Demonstrated ability to deliver a positive customer interaction, selling products and up-selling/cross-selling products
Meet/exceed all monthly key performance metrics
Deliver accurate product information and serve as a knowledgeable resource for our customers
Basic math skills and analytical ability necessary to respond to billing inquiries
Strong interpersonal skills and respect for diversity
Attention to detail and time management
Good communication skills, written and oral
Demonstrated ability to handle multiple tasks at one time

Senior Claims Resolution Representative Resume Examples & Samples

Excellent verbal, written communication skills
Strong listening skills
Good organizational skills with the ability to multi task, prioritize and follow up
High School Diploma or equivalent
Typically has 4- 6 year’s Customer Service experience in a call center environment
Home Warranty or real estate experience desirable

Claims Resolution Representative Resume Examples & Samples

ANSWERS ALL INQUIRES RELATING TO CLAIMS RECEIVED VIA THELEPHONE AND/OR US MAIL. TAKE CARE OF PROBLEMS RECEIVED FROM STOCKON CALL CENTER, CSC, PROVIDERS, HEALTH PLAN OFFICES, AND OTHER KP DEPARTMENTS BY RESEARCHING THROUGH THE USE OF CATS, VANTIVE AND OTHER RELATED COMPUTER SYSTEMS (CLAIMS POLICIES AND PROCEDURES, GUIDELINES, MEMOS, ETC)
INDEPENTANTELY RESOLVE PROVLMES PRESENTED, WHICH MAY INCLUDE, BUT NOT LIMIITED TO, ADJUSTING AND PROCESSING CLAIMS FOR PYAMENT AND/OR FORWARD THEM TO THE APPROPRIATE INDIVIDUAL FOR RESOLUTION
COMMUNICATE ALL APPROPRIATE INFORMATION ABOUT THE RESOULTION BACK TO THE PROVIDER AND/OR MEMBER
IDENTIFIES CLAIM ERRORS AND OTHER REQUIRED INFORMATION NECESSARY TO HANDLE PROBLEMS IDENTIFIED WITH MINIMAL SUPERVISORY ASSISTANCE
INDENTFIES ALL APPROPRIATE CLAIM ADJUSTMENTS NECESSARY TO RESOLVE PROBLEMS AND ENSURES THAT THEY ARE COMPLETED NI A TIMELY AND ACCURATE FASHION
INDEPENDENTLY EXERCISE GOOD JUDGEMENT IN DETERMINING PROBLEMS AND RESOULTIONS. PERFORMS ALL DUTIES AND RESPONSIBLITIES WITH A CONSIDERABLE AMOUNT OF PATIENCE AND TACT
PROVIDES A SERVICE TO THE STAFF OF VARIOUS HEALTH PLAN OFFICES BY REPSONING TO THEIR QUESTIONS REGARDING CLAIMS PROCESSING
PERFORMS OTHER RELATED DUTIES AS ASSIGNED BY THE SUPERVISOR; PROVIDE TRAINING AND ACT AS OTHER AREAS OF THE CLAIMS DEPARTMENT
TWO TO FOUR YEARS EXPERIENCE IN AUTOMATED CLAIMS ENVIORNMENT
TWO YEARS WORKING IN THE CHATS, AOMM, OPVS, OTRS, FOUNDATION AND VANTIVE SYSTEM
THOROUGH KNOWLEDGE OF CLAIMS PROCESSING PROCEDURES, TERMINOLOGY, PRACTICES AND EQUIPMENT, MEDICAL TERMINONLY AND BUSINESS MATHEMATICS
EXECELLENT ANALYTICAL SKILLS AND THE ABILITY TO WORK EFFECTIVLY UNDER HIGHLY STRESSFUL SITUATIONS
MUST BE HIGHLY PROFESSIONAL, COURTEOUS AND SELF-MOTIVATED AS WELL AS CUSTOMER SERVICE ORIENTATED WITH THE ABILITY TO DEFUSE DIFFICULT SITUATIONS
CPT-4, ICD-9, MEDICAL TERMINOLOGY, MEDICARE, MEDI-CAL, CONTRACTS AND PC LITERACY REQUIRED

Credit Resolution Representative Resume Examples & Samples

Performs refund and credit analysis, audit and reimbursement functions for all patient credit balance accounts 60%
Responsible for the review, preparation and submission of the Credit Balances Quarterly Report. 10%
Responsible for follow up on credit balance accounts 5%
Responds to patient inquiries and Insurance phone calls regarding account balances and refunds. 5%
Handle correspondence received from payors requesting refunds 5%
Reports on root causes of Credit Balances to management 5%
Interacts with facilities to resolve accounts 5%
Other duties as assigned by Management 5%

Senior Recovery Resolution Representative Resume Examples & Samples

Coordinates with the Cost Containment Manager and / or Team Lead on workflow distribution and first in first out handling of correspondence and recovery processes including manual systematic posting and auto recovery by offset by claim payment adjustments
Demonstrates depth of knowledge / skills in own area and often able to apply these outside of own function
Solves complex problems on own; proactively identifying new solutions to problems
Capable of planning, prioritizing, organizing and completion of work to meet established objectives
Works with payers / providers to review claim information and identify issues related to payment accuracy which may include initiating telephone calls to gather information
Manages conversations with stakeholders to ensure clear understanding and that accurate information is obtained
Drives resolution of overpayments based on relevant claims processing information, policies, and regulations
Verifies and ensures that received overpayment refund checks are properly applied to the appropriate claims
Enters information into applicable systems using predefined parameters to ensure accurate tracking and reporting
Addresses concerns/inquiries from providers (e.g., obtaining commitment of provider / other entity to refund by check or permission to offset when indicated
Responsible for maintaining a 95% quality standard and production standard of 7 claims per hour on transactions
Reports and monitors overpayment identifications and resolutions in order to establish and measure progress against targets and objectives
Identifies implements and reports opportunities to improve processes, procedures and systems to drive improved quality / efficiency and strengthen stakeholder relationships
Performs all other related duties as assigned
Previous claims examiner experience
Two to four years of health care claims processing experience
Medical terminology, 10-key and computer literacy
Proficient with Medicare processing guidelines, working knowledge of medical contracts, RBRVS, facility and ambulatory payment methodologies
Exceptional ability to organize, prioritize and communicate effectively
Must have commonly-used knowledge of claims examination concepts, practices and rules, ICD and CPT coding and network contracts
Ability to make decisions based on sound knowledge
More than five years related experience
Advanced training in claims processes

Account Resolution Representative Resume Examples & Samples

Essential computer skills on a PC or Mac
Basic knowledge of CPT and ICD-codes
Basic knowledge of FDCPA
Ability to work with a team setting and be supportive of the team members
Ability to work successfully in a fast paced environment
Office Work Environment

Claims Resolution Representative Resume Examples & Samples

Fundamental understanding of Home warranty polices and appliances
Good listening, verbal and written communication skills
Good organizational skills with the ability to multi task prioritize and follow up
Strong problem solving and conflict resolution skills
Typically has 2-4 year’s Customer Service experience in a call center environment

Credit Resolution Representative Resume Examples & Samples

Research credit balances on patient accounts
Make posting corrections as necessary
Research and post refunds appropriately in patient accounting system
Determine the correct course of action to resolve the refund request or credit balance which could include but not limited to
Update credit balance/refund work queue as necessary
Utilizes all available resources (EOBs, IMAGENOW, payor websites, Availity, Navinet) to ensure refunds/takebacks (recoupments) are adjudicated correctly
Notifies payor representative to initiate takeback (recoupment), and provides support documentation as required to the payor representative
Provides all required documentation necessary for refund approval
Prepares approved refund requests and submits to Team Lead for review and in turn submission to finance for reimbursement
Updates billing system to ensure that refunds/takebacks are properly documented
Identifies all misallocated reimbursement for proper disbursement
Ensures complete, accurate, and timely account notation and documentation in the Revenue Cycle systems, including adjudication and denial processing
Daily focus on attaining productivity standards, recommending new approaches for enhancing performance and productivity when appropriate
Complete and/or attend mandatory training and education sessions within approved organizational guidelines and timeframes

Senior Subrogation Resolution Representative Resume Examples & Samples

Coordinates and recovers moderately complex subrogation cases under limited team manager supervision
Conducts investigation to develop subrogation prospects. Evaluates subrogation potential and pursues appropriate recovery
Negotiates settlements with responsible parties, their carriers or legal counsel
Communicates with policyholders, vendors and agents on the status of pending subrogation matters, where required by statues, regulation or service standard
Processes recovery reimbursements and vendor expense payments within established authority
Preserves evidence and protects the chain of custody
Adheres to all applicable statutes and regulations and corporate compliance protocols
Reimburses insured’s deductible where appropriate
Good interpersonal, analytical and negotiation abilities required. Time management skills are essential
Strong verbal, written and conflict resolution skills needed
Knowledge of legal liability, general insurance policy coverage and exposure required
The capabilities, skills and knowledge required is normally acquired through an Associate's degree or equivalent experience and 1 year of directly related experience

Lead Credit Resolution Representative Resume Examples & Samples

Knowledge and understanding of the Credits process
Healthcare terminology and reimbursement rules
Insurance Plan payment methodologies and contract terms
Leadership qualities of ownership, personal responsibility and good decision making
Three or more years of Credits background or equivalent combination of experience and education
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
Hospital Work Environment

Account Resolution Representative, Chicago Resume Examples & Samples

Build relationships and gain trust of Owners and Dealer Principals in financial distress for possible workout solutions
Develop and maintain a network of ancillary services such as auto transport firms, storage compounds, vehicle wholesalers
Perform “book” audits
Keep records of activities and transactions ranging from daily activity reporting to vehicle remarketing and liquidation
5+ years current or recent experience in bank, automotive finance, or financial services company with credit, vehicle inventory audits, and loss mitigation responsibilities
Ability to manage stressful situations with customers (face-to-face) who are likely in a default or difficult situations
Commercial Collections experience

Account Resolution Representative, Alabama Resume Examples & Samples

Communicate with Owners and Dealer Principals while being physically present during troubled situations such as, fraud, bankruptcy, and "sold out of trust" (Dealership is funded on sold vehicles without paying ACS)
Coordinate extensively with the Credit and Legal Department
Collect payment from Dealerships as needed as well as secure vehicle collateral, keys, and title management when necessary
Monitor Dealership sales transactions
10+ years of current or recent experience in bank or auto finance credit and loss mitigation responsibilities
Dealership Floorplan experience
Microsoft Suite experience

Account Resolution Representative Resume Examples & Samples

Partner with Dealer Relationship Managers in supporting regions and have open communication throughout process
Protect collateral for ACS by keeping Management informed of activities that could affect loss exposure (being the eyes and ears of ACS during workout or liquidation activities)
Provide routine physical inventory audits to supplement third party vendor audits, as needed
Communicates effectively and openly with both internal and external functional groups. (Credit, Operations, Legal and Outside counsel)
5+ years of experience in financial procedures, policies, and financial credit system

Senior Recovery / Resolution Representative Resume Examples & Samples

Provide claims expertise support by reviewing, researching, investigating, negotiating, and resolving all types of claims from providers as well as recovery and resolution for health plans both commercial customers, and government entities
Obtain all available data relevant to the investigation of potential claim overpayment
Utilize auditing tools to identify and determine accuracy of claims payments (prospectively and retrospectively)
Prepare/generate claims overpayment billing along with explanation of the reason for overpayment and mail it to the appropriate provider
Pursue recoveries and process / code overpayment / refund check
Verify the refund check or debit offset is properly applied to the appropriate claim in the applicable System
Analyze, identify, and report claim overpayments and resolutions to the Management Team
Communicate effectively with internal / external clients
This candidate is expected to act as a Claims resource for others in the Revenue Recovery department
2+ years of healthcare claims auditing, analyzing data, recovery, and collections experience
1 year of customer service experience analyzing and solving customer problems
Proficiency with computer and Windows PC applications
Experience in claims recovery resolution
Knowledge of healthcare coding practices
Strong communication skills (both written and verbal)

Claims Resolution Representative Resume Examples & Samples

Prepares and transmits patient claims in the appropriate claim format according to guidelines
Consults with appropriate personnel to resolve unbilled claims. Reviews recent accounts for proper billing practices and reimbursement
Investigates and provides follow-up resolution documentation on patient billing issues and questions
Assists in investigating denials as necessary to obtain appropriate payment or prioritizes retro-authorization requests
No experience required, but some experience preferred

Download Resolution Representative Resume Sample as Image file