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PHONE NUMBER AVAILABLE EMAIL AVAILABLESummary of Qualification*Extensive Multi-Line Claims and Appeals experience: Inception to Final Resolution*Extensive customer service, investigations, research and troubleshooting experience, Managed care, appeals, collections, credentialing, contract compliance, grievance resolutions and Workers Compensation*Strong ability to work within a team member or independently with minimal supervision.EducationMBA  Public Administration Strayer University Graduate 12/2019Bachelor of Science in Paralegal Everest University Graduated 11/2014Skills*Multi-Line claims processing, adjuster and billing (From inception to final resolutions) which includes appeals and grievances: *Auto/PIP, Bodily Injury/Med-Pay, Commercial, Endorsements, FNOL, FSA, Homeowners, Medicaid/Medicare, Property Casualty, General Liability, Boiler Machinery, Umbrella and Workers Compensation. Claims Systems to include - EDI/Emdeon, CPR+, AXIS, NextGen, Legacy, Blue 3, Intra-Plan Messaging System, BPM Framework, Call Care Browser, Citrix, Cerner, Facets, GPOO, GUI System, IPD Ultera, ITS, Legacy, Great Plains, Infosys, NASCO, NextGen, PLEDGE, TAP, WGS, OnDemand, CareVoyant, Mediformatix, ZirMed; CISCO, Availity, *Microsoft Office Applications, Desktop Agent Telephone System*EDI & EHR, ICD-9/10, CPT, HCPC coding, OSHA and HIPPA Certifications and Credentialing; Scheduling, CMS Compliance.*CMS Medicare and Medicaid Appeals and GrievancesCertificationFirst Coast University (CMS) - Medicare/Medicaid CEU TrainingState of Florida 620  All Lines Claims Adjuster (2013)State of Florida 440 - Certified Professional Service Representative (2007)OSHA and HIPAA CertificationCPCU Designation  Currently pursuing  Actuary, Fraud, Risk Management & UWEMPLOYMENT HISTORY:AdventHealth-CentraCare 03/2017 01/2019 PFS Reimbursement Specialist II*Responsible for processing and billing medical insurance claims.*Reviews assigned EDI claims error and EHR A/R reports*Review EOBs for additional coverage to calculate secondary and tertiary billing*Research and reprocess corrected claims, proof of timely filing, appeals, write-offs.*Resubmission of corrected/rejected claims, Medical records via EHR.*Communication with patients and vendors for claim status and corrected claim data.ACS-Omnicare, Orlando, FL 10/2015  04/2016 Biogen Client Specialist II*In-depth knowledge of Multi-insurance plans to include PBMs and major medical.*Conduct prior authorizations, appeals. and copay assistance plans.*Knowledge of Medicare/LIS status programs*Ability to work in a fast-paced environment*Review EOBs for additional coverage to calculate secondary and tertiary billing*Process medical claims from inception to final resolutionClermont Radiology, Orlando, FL 08/2011-8/2014 Claims Adjuster/Collection Manager*Process claims from inception to final resolutions including aging A/R.*Acquire information and authorization to file letters and post remits*Review EOBs for additional coverage to calculate secondary and tertiary billing*Research and reprocess corrected claims, proof of timely filing, appeals, write-offs.*Claims-FEP Workers Compensation, MVP/PIP, Managed care, and Medicaid/Medicare.ALERE, Inc., Orlando, FL 04/2010-08/2011 Billing & Claims Collections Specialist*Claim entry, billing/collections aged A/R and patient responsibility accounts.*Review EOBs for additional coverage to calculate secondary and tertiary billing*Research and reprocess corrected claims, proof of timely filing, appeals, write-offs.*Prepare and process secondary and tertiary claims via EDI and EHR systems.*Process corrected claims, proof of timely filing, initiate appeals, write off dead claims.* Medicare/Medicare, Managed Care and Workers Compensation claimsAnthem-WellPoint, Worthington, OH 09/200801/2010 Claim Adjuster*Address providers inquiries of claims, adjustments, and final resolution remittances*Examined incorrect clams and reprocessed based on contractual rates.*Review EDI and paper claims for correct ICD-9 and HCPC codes for proper billing*Process major medical claims to include Medicare/Medicaid, Managed Care andWorkers Compensation; Research, correct/reprocess claims in a timely manner for remit.*Generate, research and process claim determination and additional information letters to proceed with claim settlement or appeal for final resolution.VOLUNTEER SERVICES:The Black Butterfly Initiative 2000  Current President and Chief-Executive OfficerThis program was created to address the many needs of individuals and families which have fallen through the cracks in terms of not being qualified for specific programs and or services. Our program is directed toward those who openly demonstrates the will and the need to transition from dependency onto self-sufficiency i.e. being fully trained to acquire above minimum wage annual salaries, defeat the ploy of poverty, acquire housing, extract themselves and their families from generational cycles of illiteracy, hunger, homelessness and overall poverty.