| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLEPHONE NUMBER AVAILABLEHIGHLIGHTS OF SKILLS and QUALIFICATIONSHIPAA/ERISA-compliant health insurance benefits specialist. Excellent writtenand verbal communication skills. Resourceful problem -solver with excellent organizational and prioritizing skills. Strong and effective time management anddecision - making skills. Professionally courteous and diplomatic customer- relations specialist.Extensive knowledge of Managed Care (HMO, POS, EPO, PPO) health planadministration. Working knowledge of ICD -9 and CPT coding and MedicalTerminology. Microsoft Word, EXCEL, ACCESS, Quicken, Word Perfect software experiencePROFESSIONAL EXPERIENCESPERSONAL CAREGIVER- 2008- 2020.* Provided personal home care for a terminally ill cancer patient, transportpatient to and from chemotherapy at Atlanta cancer care* Administered medicine/ Neulasta IM for the patient to maintain a normal whiteblood cell count as possible* Observed patient for any side effects and or adverse reactions to drug suchas nausea and vomiting, blood pressure.* Performed Venous punctures for lab work, label and deliver to Cancer care LaboratoryFor two and a half yearsBLUE CROSS AND BLUE SHIELD OF GEORGIA - UTILIZATION MANAGEMENT REPRESENTATIVE II - 2003 to current 2008* Received, managed and resolved all inbound telephone queue calls,initiating the prior authorization/pre-certification process by obtaininginformation to determine member eligibility, provider participation status andbenefits coverage, entering the information in the utilization management system,prior to referring all clinical calls to medical review staff.* Accurately documented information using appropriate documentationstandards.* Performed data entry of medical referral cases and approval status forprocedures not requiring clinical review, assigning ICD-9, CPT, DRG and servicecategories, consistently adhering to HIPAA and ERISA regulations and corporatepolicy/procedural guidelines.BLUE CROSS AND BLUE SHIELD OF GEORGIA - CLAIMS SPECIALIST III - 2001- 2003* Adjudication of group HMO, POS, and PPO medical claims, in accordance withmultiple provider reimbursement agreements, AMA coding guidelines, HIPAA andERISA regulations, and various group policy guidelines.EDUCATIONGeorgia Perimeter College - Clarkston, GeorgiaA.A. Degree DeKalb College |
