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Click here or scroll down to respond to this candidateCandidate's Name
To secure a position will capitalize on my administrative, customer relations and problem-solving skills in an organization that offers growth and advancement. Education: Woodrow Wilson High School Dallas, TX August 1989 to May 1992 Skills:Program/System Experience: AHIQA, Appeals & Grievance Software, ADP iPay, AS400, Adobe Acrobat & Reader DC, Availity, Blue Source, Blue Star, Centers for Medicare & Medicaid Services, Copy Machine, Claim Viewer, Check Tracer, CISCO Jabber Instant Messaging, Concur, CyraCom Translation Services, Document Imaging, Dashboard, Emdeon, Encoder Pro, Epic, Fax Machine, Finesse PG-15, Google Chrome, Health Care Insight, IMNU, iHealth, iLearn, Internet Explorer, Kronos, Laminating Machine, Lotus Notes, Master Provider File Viewer, Microsoft Office (Excel, Outlook, PowerPoint, and Word), Mozilla Firefox, Net Access, Nitro Pro 9 & 10, Office of the Inspector General, PDF Creator, QNXT, RTB, Scanning Machine, SharePoint, SnagIt, Snipping Tool, Texas Medicaid & Healthcare Partnership, Typing (10-key-by-touch), UMK2, Video Relay Service Deaf Network of Texas, and WebEx (10+ years) Subject-Matter-Expertise (SME): Adaptive Aids, Adult Day Care, Appeals/Reconsiderations & Complaints/Grievances (Member, Provider, HHSC, and TDI), Behavioral Health, Benefits, COBRA, Centers for Medicare & Medicaid Services, Claims, Commercial Insurance (HMO, PPO, POS, EPO, and HSA), Contracting, Cost Recovery, Credentialing, Dental, Disease Management, Durable Medical Equipment, Early Childhood Intervention, Eligibility/Enrollment, HEDIS, HIPAA, Health & Human Services Commission, Health Insurance Marketplace, Home Health Care & Modifications, Hospice, Intellectual & Developmental Disabilities, Long Term Care, Long Term Services & Supports, Managed Care, Medical Coding, Meals-on-Wheels, Member Services, Nursing/Skilled Nursing, Pension & Retirement Plans (401k), Pharmacy (Mail Order, Retail, and Specialty), Prior Authorizations, Provider Services, Qualified Domestic Relations Orders (QDROs), Radiology (including High-End Radiology), Referrals, Respite Care & Services, Service Coordination, Subrogation, Supplemental Security Income, Texas Department of Aging & Disability Services, Texas Department of Insurance, Texas Health & Human Services, Texas Healthy Steps, Texas Medicaid & Healthcare Partnership, Texas Vaccines for Children Program, Transportation, Utilization Management, Value Added Benefits, Vision, and Waiver ServicesCertifications/Licenses:Medication Administration January 1997 to Present Medical office Data entry Medical terminology Medical codingWork Experience:Healthcare Support Group/ Alliance Rx Walgreens Prime Specialty Pharmacy Core Major Medical Verification Specialist October 28, 2019 Current Medical verification for prescription of various diagnosis Claim processing Insurance verification Billing Health Information Management Claim examinationsClerk IIPopulus Group/Molina Healthcare - Irving, TX November 2016 to May 2018 Handled calls from providers Provider intake to determine proper routing of claims, disputes, misdirected submissions and misrouted items. Determined the difference of medical records Verified medical claims Responsible for triaging and logging grievances and appeals received Reviewed paper claim inquires send by other company providers and determined if all relevant information has been included. Responsible for scanning, uploading, faxing, stamping and filing the hard copies of all claim inquiries and attachments received. Acknowledge incoming projects as true disputes and route all items to correct areas within and outside departments. Responsible of all other clerical duties such as item replenishment, uploading files, mailroom communication, and internal and external file storage organization. ClerkAd A Staff/ Dallas County/DISD - Dallas, TX August 2015 to November 2016 Data entry Scanned private wills Filed documents Responsible for each head accountability count for disabled children Determined eligibility for special needs for example: bus ride, medical equipment during and after school.DirectorLife Span Rehabilitation Center of TX - Dallas, TX July 2012 to April 2015 Maintain medical records and variety of reports for each individual in the rehab. Schedule events, doctors appointments and educational activities. Insurance SpecialistsHMS/Healthcare Management Services - Irving, TX February 2006 to July 2008 Verified insurance claims such as, PPO HMO MEDICARE DUALS MEDICAID etc... Data entry Answered multi lines phone |
