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Click here or scroll down to respond to this candidateCandidate's Name
Peoria, AZ e: EMAIL AVAILABLE p: PHONE NUMBER AVAILABLEPROFESSIONAL SUMMARYI am motivated, assertive, and highly organized with exceptional leadership and interpersonal skills. I possess over 20 years in the Healthcare Administration/Insurance industry with an emphasis in Grievances and Appeals. I am well-versed in medical claims processing, including Medicare, HCFA, UB92, and high-dollar complicated claims. I have experience with a multitude of programs and am proficient in Microsoft Office 365 and Google Office Suite. I would like to share my knowledge and experience with a reputable company that challenges me and offers opportunities for growth and recognition.SKILLSExpert in medical terminology, CPT, and ICD-9 / ICD10 codingProficient in reviewing medical claims such as: HCFA 1500, Universal Claims, Stop Loss, COB and DRG/RCC Pricing, Surgery/AnesthesiaInterpersonal communication, relationship buildingExcellent leadership and delegation capabilitiesProficient in medical billing, medical records, medical scheduling, HIPAA complianceProficient in Arizona Administrative CodesKnowledge in anatomy and physiologyProficient in Grievance and appeals processes and proceduresInsurance verification, proficient in Medicare/Medicaid guidelinesProficient in Microsoft Office (Word, Excel, Outlook)Knowledge of home/mortgage loan acquisitionsCPR/First Aid certifiedFluent/bilingual in English (US) and Farsi (Persian/Iranian)WORK EXPERIENCEDiscover Financial Services Personal Banker, February 2021 to PresentPersonal Banker in the Home Loans DepartmentAnswering high call volumes and assisting clients with applying for mortgage refinancing and home equity loansTop 5% on the sales team/Elite status within first year of employmentResponsible for answering inbound (75%) and emails (25%) to assist customersCollaboration with other departments to assist in obtaining documents and information needed for loan completion and processingPart of the Employee Advisory Team to assist with implementation of procedures and policiesEducated customers on home/mortgage loan process, providing important information while maintaining federal and state-level compliance in confidentiality and procedureConsistently exceeds metrics on monthly basis for successfully onboarded home equity and mortgage loansLead Grievance and Appeals Analyst Blue Cross Blue Shield of Arizona, August 2016 to February 2021Responsible for approved/denied insurance claims for both BCBS members and providersFacilitates resolution of member grievances, standard appeals, and expedited review requests.Initiates, monitors, and finalizes adjustments on reversals, according to regulatory standardsMaintained 100% compliance in all federal and state-level medical appealsBecame Subject Matter Expert and led department training by creating the current system of Desktop Procedures and Knowledge Base for department. Created and standardized department SOPs.Billing Specialist Eye Institute at Boswell July 2013 to August 2016Provided insurance and patient billing / posting charges and paymentsReconciled patient payment records and monthly invoicesResearched and verified patient insurance claimsFiled appeals/disputes for claim payments / processed patient and insurance refundsPrepared end of month reportsAppeals Analyst Care1st Healthplan of Arizona, June 2010 to July 2013Responsible for tracking and logging all provider appeals and member grievances100 % resolution of Acute and Medicare Line of Business provider claim appeals while utilizing Plan Procedures, Medicare and Medicaid guidelinesFacilitated the research and resolution of complaints through interaction and communication with internal partners and physician offices, and/or contracted plan representativesLead staff meetings to review case logs and appealsAppeals Analyst HealthChoice of Arizona, April 2009 May 2010Provided administrative support to department - including opening, sorting, and distributing incoming mailOversaw data entry of incoming provider claim disputes as well as provided exemplary customer service to all membersResponsible for researching appealsAchieved all-time 100% Time Compliance while following all Federal Medicare/Medicaid guidelines in addition to plan rulesAccounts Receivable Specialist Tamar Gottfried, M.D. Private Practice, September 2006 April 2009Verified all insurance benefits for obstetrical and surgical benefitsCreated and implemented a new tracking and organization system that documented all posted charges and payments to patient accountsResponsible for scheduling in-office procedures (inpatient and outpatient surgery) while providing best-in-class customer service to all in-office and on-phone patients with a minimum 85% on phone usageScheduling/Billing Coordinator University OB/GYN, June 1995 to September 2006Processed patient invoices and billing, reconciled patient and insurance paymentsPosted and organized process payments within office database/filing systemMaintained HIPAA compliance and patient confidentiality when handling sensitive informationAssisted in scheduling appointments, knowledge of medical/OB procedures and terminologyProvided back-office assistance to healthcare providers and patientsCoordinated patient appointments and transfers with other healthcare facilities in Mesa, AZ areaEDUCATIONMesa Community CollegeAssociate of Applied Science in Biology (AAS)Graduated May 1997Reseda High SchoolHigh School DiplomaGraduated June 1988*References available upon request |
