Proficient in Microsoft Word, Excel, PowerPoint, Publisher, Outlook, Strong Internet Research.
Trained in CPT-5, ICD-9, and HCPCS coding
Strong leadership skills – able to problem solve issues that arise in the workplace in a professional manner
Experience in all aspects of insurance: Medicare, Medicaid, and third-party payers knowledgeable in Medical Billing and Coding Guidelines
Manage multiple tasks at once, with strict adherence to time constraint
Excellent communication skills – Trained and experienced in group facilitation and conflict resolution.
Can articulate opinions written and orally. Understanding of Spanish.
Highly detailed and customer service oriented and functions well independently or as a team member Experience
Tufts Health Plan Medicare Preferred (Watertown, Ma) November 2012 – Current
Member Services-Call Center

• Responsible for verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments
• Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing.
• Verify, document and investigate the presence of health care coverage for Medicare recipients 65 or older\ disabled
• Complete periodic reports.
• Customer service to include high volume of phone work answering questions and other inquiries regarding Tufts Health Plan
• Data entry to include accurate and timely entry of information.
• Obtain and/or verify all items related to eligibility and enrollment into Medicare health plan(s)
• Complete maintenance of active cases during open enrollment and premium review.
• Answer & receive inbound, outbound calls regarding assistance in premium billing, co-pays for pharmacy or medical visits.