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PHONE NUMBER AVAILABLE EMAIL AVAILABLEInsurance Claims Customer Service AppealsEmployment HistoryAppeals and Claims Support Service Clerk, ROI/HIMS Clerk, Member Relations Support ClerkKaiser Permanente 12/01/2008-Present.Update and support the database used by the Appeals/Grievance Dept. by creating cases intothe METRS database for each case we receive daily.e Review each incoming correspondence by reviewing denial codes appeals letters and complaints.Create METRS cases on earlier scanned correspondence and Multi Plan claims daily.Pricing for Medicaid Reimbursement, Correspondence using Maces, Hyperspace, and Vignette systems.Trained in HIPAA Law, processing CMS-1500, UB-92, Member Reimbursements, and Dental Claims.Enter claims into the hyperspace system daily; verify and update all member's insurance and claims.Denied claims for other information needed for processing each claim.Process member Appeals Before the 30-day turnaround Period. Process All Urgent Appeals Within The7-day Tum-Around Period. Process All Sr. Adv. Appeals Before The 60-Day Tum Around Period.Sort, Investigate, and Process All Provider Appeals within the 60 Day Tum Around Periode Investigate All Denials When There Are Referrals and Codes through different Depts.,Physicians and Providers.e Create CRMs and Link Docs and Correspondences into the Cars System.e Review CRMs, Notes, and Letters to decide if a Member's Fees should be waived.Manage All Complaints from Members and Providers and Sort Them for the Different Depts.That Manages them accordingly.Research and understanding all Complaint and Appeals before creating each case into METRS.ROI Itemized Billing and Radiology Request data entered in HyperSpace/Epic for processing daily.Research ROI members' complaints and contact Members to manage all complaints.e Assist Members at the front desk for Records and Correspondence pick-up daily.Unit Manager/Customer Service Clerk Nationwide Credit, Inc. 07/1996-09/2006e = Thirteen years of experience in providing superior customer service.e Ten years in a call center environment with high call volume and a need for conflict resolution.e Trained and promoted over 40 new employees a month in collections, payments, and conflictresolutions.e Specialized in data entry of consumer personal information, accounts receivable & accounts payable.Medical Records Clerk/Front Office Clerk West End Medical Center 12/1991-06/1996 Checked patients in and out to be seen by the physician, and scheduled patient appointments andreferrals.e Helped oversee all aspects of ensuring patients receive quality service; updated all patient information.e Analyze patient's charts to ensure charts are updated and completed daily.e Scheduled reservations for patients to pick up medical records.e Filed patients' records and labs in charts and prepared charts for doctors to see patients daily.Education(CERTIFIED MEDICAL TERMINOLOGY/CERTIFIED FRONT OFFICE CERTIFICATIONCompleted: MEDICARE PART D: GRIEVANCES, COVERAGE AND DETERMINATIONS & APPEALS 2018 |
