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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLEEducation:Brandon High SchoolMajor: High School DiplomaProfessional ExperienceAlignment HealthcareClaims Processor4/2018-6/2019Aided in the correction of procedure and diagnosis codes to allow payment from the insurance companyAssisted patients in creating payment plans, getting discounts, and medical assistance to prevent their accounts from going to collectionsPayment by insurance carriers and achieve timely billing and prompt accounts receivable turnover (CIGNA, AETNA, HUMANA, BCBS, MEDICARE)Implemented electronic claims transmission system. Electronic claims submissions, appeals, authorization tracking, patient accounting, interaction and implementation of patient payments on delinquent accountsBilling plans such as HMOs, PPO plans, Dental plans, Medicaid, MedicareTraditional medical plans to complex managed care arrangements.Works communicates and collaborates in harmony and in a courteous and professional manner with the patient, practitioner, provider and multidisciplinary health care team members all issues, concerns and/or as the UM Plan is revised and/or new services are implemented/terminated corresponding and adjustment via Xcelys/FACETBilling plans such as HMOs, PPO plans, Dental plans, Medicaid, MedicareMH Consulting (Contract)Claims processor1/2018-4/2018Performed claim review, processing and adjudicationReviewed claim for data and payment accuracyFinalized claim for denial of paymentReviewed and confirm contractsHealth Plan ServicesSenior Claim SpecialistOctober 2015-January 2018New Business Auditor- Auditing of new hire work, creating spreadsheets for feedback and providing reports of Audit roll up and progression to managementOnboarding- Lead trainer for iGate resources for the new business off exchange portion. Lead contact for any questions they had after training and additional training.Managed a wide variety of customer service and administrative tasks/projects to resolve member billing and health plan policy issues quickly and efficiently.Provided member policy plan maintenance that included demographic change, dis-enrollment, reinstatement, and plan/policy change.Processed 834 files for BSC On exchangeSenior Customer Care AssociateJune 2014-October 2015Recommended health insurance products and services to members (customers) and accurately explained details of services and plan benefits.Managed a wide variety of customer service and administrative tasks/projects to resolve member billing and health plan policy issues quickly and efficiently.Provided member policy plan maintenance that included demographic change, dis-enrollment, reinstatement, and plan/policy change.Candidate Qualification Summary:10+ years of claim experience8 + years of healthcare member benefits experience5+ years of healthcare enrollment experienceExperienced with Microsoft Office ProductsAvailable Mon-Fri 8am-8pm + Overtime as needed |
