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Click here or scroll down to respond to this candidateCandidate's Name
Aspiring Data Analyst with training and expertise in all aspects of collecting, translating, visualizing, and drawing insights from complex sets of data to help solve organizational problems and challenges.EMAIL AVAILABLEEDUCATIONCONTACTGoogle Certified IT Support Specialist Street Address
Amazon Web Services In processCertificationSKILLSAssociate of Arts Criminal JusticeUniversity Texas Arlington 1989Wesleyan CollegeCertified Data Scientist 2022ENTITY Academy x Woz UMagna Cum LaudeDirectors List April and July 2022Content, Email and Inbound 2020MarketingHubSpot AcademyGithub.com/navymama/Team-PhoenixLINKEDIN LINK AVAILABLE/Senior Benefits Specialist 2014 to PresentAetna/CVS/MeritainApplies medical necessity guidelines applying precertification or medical review numbers for processing. Sending to specialized department if more intense review is needed.Determine coverage determining that member and all eligible dependents are listed as active or have termination dates if no longer active.Complete eligibility verification by ensuring correct plan and group numbers and level of coverage is listed correctly.Identify discrepancies by verifying if billed codes are correct for age gender and listed diagnosis and if listed CPT codes are appropriate.Apply all cost containment measures to assist in adjudication process.I have experience with Medicare, Medicaid, self- funded group, and commercial groups.Maintained 100+ claims per day metric and quality metric of 99% and accuracy metric of 95% or greater per month for eight years.Made process improvement on claim notifications resulting in a reduction of payment errors made during processing.Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamworkSr. Benefits Specialist/Team Lead2012 to 2021Jacobson SolutionsProcessed and adjusted medical claims for New York, Pennsylvania and other states Medicaid claims using Facets 4.71-5.0 Checked eligibility status, provider status, reviewed fee schedules and made manual pricing corrections as needed. Reviewed for correct authorization status. Worked onsite and remotely.Pricing claims on facets, applying Centers for Medicare and Medicaid processing guidelines in addition to other physician and facility rates to Veteran Administration claims.Responsible for team of 15+ to include attendance, progress reports and coaching, spotting trends.Trained new hires in processes/navigationAdvised on network/internet issues and able to offer solutions, including writing training guides/processes.Assisted in set up of VoIP equipment via chat/phone.WORK EXPERIENCEMachine LearningAdvanced AnalyticsNatural Language ProcessingStatistics and ProbabilityData VisualizationMicrosoft Office SuitePython, R, SQL, NOSQLMongoDBTableauHealthcareProduct MarketingSystem AdministrationHardwareAgile Project and Team ManagementJIRA, Trello, GitGrapevine, TXPHONE NUMBER AVAILABLEENTITY Final Project: Used Python and R to analyze drunk driving, distracted driving in relation to fatalities and created visualizations in Tableau.Texas Road Safety Project: Clean, wrangled, and explored 2013 Texas Crash Data using Python; created visualizations to showcase trends using Tableau.Entity Wants to Know: Suggested new program featuring Entity and Woz U instructors for short bios featured in upcoming newsletters and marketing materials. |
