Summary
Overview
Work History
Education
Skills
Timeline
Generic

Quinesha Hoyle-House

Summary

Customer Service Representative holds high level of professionalism and courtesy at all times. Conducts high-volume of inbound and outbound customer calls to assist callers with various issues. In an addition, highly skilled in analyzing and validating patient information, diagnoses and billing data. Demonstrated accuracy and discretion in processing patient information.

Overview

11
11
years of professional experience

Work History

Insurance Verification Specialist

CVS Pharmacy
02.2024 - Current
  • Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
  • Managed high-volume insurance verifications within pressured timeframes for productive medical operations.

Medical Claims Processor

Adapthealth
01.2023 - 01.2024
  • Verified compliance with documentation standards critical for accurate recordkeeping and claims reimbursement.
  • Classified procedures according to ICD-10 a codes.
  • Coded medical claims to secure financial recuperation from insurance providers and government health initiatives.
  • Collaborated with physicians and medical providers to clarify and facilitate clinical requests.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.

Direct Support Professional

EastersealsUCP
01.2014 - 01.2023
  • Advocated for rights of individuals with disabilities within community.
  • Collaborated with other professionals, such as therapists and social workers, to ensure comprehensive care for clients.
  • Educated family members about available resources and strategies for supporting their loved ones.
  • Prepared budgets and cost estimates for projects.

Customer Service Representative

RSVP Communications
01.2022 - 01.2022
  • Delivered fast and friendly service to handle questions and service complaints.
  • Followed up on unresolved cases to keep customers informed of progress towards solution.
  • Utilized various software programs such as CRM systems, order management tools, and communication platforms effectively.
  • Handled customer inquiries, payments and service requests.

Medical Billing Specialist

Chippenham Hospital
01.2019 - 01.2021


  • Collaborated with healthcare providers to obtain necessary documentation for claim submissions.
  • Resolved claim denials and discrepancies by contacting insurance companies or patients
  • Worked closely with physicians to accurately assign ICD-10 diagnostic codes for optimal reimbursement rates from insurance companies.
  • Played a pivotal role in maintaining positive cash flow within the organization by ensuring timely submission of clean claims and diligent follow-ups on outstanding payments.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.

Nurse Aide

Ranson Ridge
01.2017 - 01.2019
  • Specialized in delivering high quality care to dementia patients.
  • Worked alongside registered nursing staff and followed care plans.
  • Managed time efficiently during shifts to prioritize tasks based on urgency level.
  • Demonstrated strong teamwork skills by collaborating effectively with colleagues across disciplines.

Education

Phlebotomy - undefined

Rowan- Cabarrus Community College
Concord, NC
01.2019

Nurse Aide I - undefined

Rowan- Cabarrus Community College
Concord, NC
04.2013

Skills

  • Order Processing
  • Medical Terminology
  • Team Development
  • Positive and Professional
  • Technical Support
  • Adaptability
  • Patient confidentiality
  • Insurance coverage verification
  • Data entry and review
  • Prior authorization processing
  • Proficient in software
  • Data security and confidentiality
  • Medical terminology
  • Account maintenance

Timeline

Insurance Verification Specialist

CVS Pharmacy
02.2024 - Current

Medical Claims Processor

Adapthealth
01.2023 - 01.2024

Customer Service Representative

RSVP Communications
01.2022 - 01.2022

Medical Billing Specialist

Chippenham Hospital
01.2019 - 01.2021

Nurse Aide

Ranson Ridge
01.2017 - 01.2019

Direct Support Professional

EastersealsUCP
01.2014 - 01.2023

Phlebotomy - undefined

Rowan- Cabarrus Community College

Nurse Aide I - undefined

Rowan- Cabarrus Community College

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Quinesha Hoyle-House