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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Como Park BlvdLancaster, NY Street Address
EMAIL AVAILABLEOBJECTIVETo obtain a position with your company where I know I will be an asset and will apply myself to my fullest capabilities.PROFILESkilled employee with over 10 years experience in management and customer service.Extensive background in hiring and training personnel, organizing and managing distribution routes, as well as direct interaction with customers.Proficient in several applications, including these:Microsoft ExcelMicrosoft WordMicrosoft PowerPointSequelPROFESSIONAL EXPERIENCEFidelis Care, Buffalo, NY 3/20 - presentOperations Configuration & Integration Analyst -Analyze, interpret, load, test and maintain configurable tables, files and software that are utilized to support claim adjudication which include and but are not limited to; claim adjudication rules edits, benefit plan support, and provider reimbursement rulesResearch and resolve claim problems or issues that are configuration related in a timely and accurate mannerInteracts and coordinates system programming changes and schedules as necessary with Business Analysts and ProgrammersFidelis Care, Buffalo, NY 3/18 3/20Claims Business Analyst -Create test data and execute User Acceptance Testing to implement changes to Facets systemReview and report defects when found on test cases to ensure all errors are correctedPerform analysis and testing on multiple team projects within the companyCommunicate status of projects with colleagues and managementAssist in training new team members to familiarize them with testing procedures and programsFidelis Care, Buffalo, NY 3/17 3/18System Resolution Coordinator
Resolve claim disputesReview provider contracts for pricing disputesReview members summary of benefits, claim history and enrollment status to make an informed decisionFamiliar with CPT/HCPC and IDC10 coding, guidelines and proceduresFidelis Care, Buffalo, NY 08/16 3/17Claims Review Analyst -Verify and update information on submitted claimsCommunicate with management the issues that may affect the reviewIdentify billing trendsFidelis Care, Buffalo, NY 01/16 8/16Claims Processor -Input detailed data into accounts within the database; open and review claims using available documentationFollow organization standards and adhere to departmental, state, and federal guidelinesRecognize trends and identify the problemsSkilled in processing Medicare claimsFidelis Care, Buffalo, NY 05/15 01/16Authorization Coordinator
Communicate with providers regarding authorizations, modifications, denials and other matters pertinent to processing authorization requestsResponsible for meeting the performance measurement standards for productivity and accuracy for processing of authorizationsEDUCATIONBuffalo State College, Elmwood Avenue, Buffalo, NY 1999-2003Bachelor of Arts in History |
