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Click here or scroll down to respond to this candidateCandidate's Name
CLAIMS ANALYSTAZPHONE NUMBER AVAILABLEEMAIL AVAILABLEOBJECTIVEStrengthening Business Relationships while Utilizing Developmental Skills to Enhance Customer Experiences through Ethically Productive Reinforcement of Company Standards.EDUCATION & LICENSES
EXPERIENCEBusiness Healthcare Management, LA, Remington College2010-2012AS in Computer Electronics, IL,Olive Harvey College,1984-1987H.S Diploma, IL,Bowen High School,1978-1982Certified Pharmacy Technician _ ARIZONA BOARD OF PHARMACYPTCB - Pharmacy Technician Certification Board (PTCB)(Exp. 09/30/2024) _ Pharmacy Technician Certification BoardNational Pharmacy Technician2020-PRESENTPatient Care Technician AZ Express ScriptsManage Hundreds of Claims by Directing Litigation Processes Across Several Healthcare Sectors, with Attorneys & Insurance Companies, to Acquire, Maintain & File Reports in Patient Records.Resolve Intricate Procurement Issues Raised in Pull Department.Virtual Copying, Faxing, Data Entry, Transcription from Customer Support Interactions, & Manage Overall Communications to Elucidate Patient Benefits.Initiate Investigations for Prescription Orders.Perform Follow Up Calls on Prior Authorization, Appeals, & DOD Accounts.2016-2020Claims Analyst AZ Centene CorporationRefined Electronic & Paper Claims for both Medicaid & Hospitals.Analyzed, Reviewed, & Updated Claims for Accuracy, Completeness & Eligibility Review in order to meet Billing Requirements & Payer Demands.Actively Managed Claims Process to Ensure Timely Resolution for Validity of Records.Identified & Denied Duplicate Claims.Team Lead Investigator of Missing Claims, Provider Info & EOB Accounts & Calculations.Input Proper ICD-9/10 & CPT Codes & Attached Flawless Referral/Authorizations.Reviewed Med. Records for Optimal DRG Assignment & Reported Findings to Coding Manager.Coded High $/Volume Inpatient Records (Cardio, Radio, Gastro, Neuro, etc.).Implemented State of the Art Formulas to Improve & Monitor Workflow for Daily/Weekly QA Status Reports.Recognized as The Top 10 Analyst for Exceeding Accuracy & Attendance Goals by 98%.Utilized Amisys to Determine Payment & Rejection Codes.2015-2016Insurance Specialist AZ REMX Ltd.Entry, Audit, & Confirmation of Claims Data & Preferred Payments.Processed Re-Verifications by contacting Existing Clients' Insurance Providers & Prior Authorizations.Applied D.0 Regulations & Coding Guidelines to Claims Data; -4, ICD-9, ICD-10, HCPCS, ASA, & UB92 Codes/Billing Guidelines.2014-2015Certified Pharmacy Technician AZ Q O L MedsPrescription Prep; Data Entry of Patient Demographics, Drug Allergies, Pharmaceutical History & Orders.Superb Customer Service Skills while Greeting Patients, Phone Reception, & Filing.Maintained Drugstore Cleanliness, Pulled/Stocked, Poured, Counted, Restock/Packaging, Labeling & Pricing Prescriptions, Mail Order, Balancing Cash POS & Sending in Receipts to Corporate.KEY SKILLS
PRIOR EXPERIENCEMicrosoft Office365 Software (Windows10, Word, Excel, PowerPoint, Publisher, and Access).Customer ServiceClaims InvestigationComplaint ResolutionQARisk Management Support & ReportingRelationship BuildingPatient Care Technician, AZ & LA, UnitedHealth Group, 2013-2014Certified Pharmacy Technician, LA, Walmart Supercenter Pharmacy 2012-2013Pharmacy Technician, LA, GPS PHARMACY-TAMPA LLC 2008-20011Electronic Technician, LA, EARL K LONG HOSPITAL 2000-2008CTA & CATS Bus Operator, IL & LA, LSU Students from 1993-2013Tax Agent for Jackson Hewitt in Chicago IL 1990-1993Oscar Mayer Ambassador 1984-1989Dental Assistant 1982-1985REFERENCESAvailable Upon Request |
