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Click here or scroll down to respond to this candidateCandidate's Name
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EMAIL AVAILABLEPHONE NUMBER AVAILABLESUMMARY:A Medical insurance and office professional with experience in coding, benefits programming, billing, claims processing, prior authorization, Pharmaceuticals, staff supervision and training. Acts as a technical expert and liaison providing feedback and answers for internal and external stakeholders, with a detailed understanding of how and why payers and payees benefits get paid as they do. STRENGTHS INCLUDE:Multi-tasking across multiple systems, dedication to the task, loyal and honest hard worker, attention to detail, takes initiative, Team player, excellent communicator and with compassionate customer service skills. Expert in Excel, Microsoft windows and a wide range of the computer systems used in medical billing, coding, benefits, insurance, and the varied office and programming systems that support the industries specific systems.WORK EXPERIENCE:Signing Agent/NotarySelf Employed I work as an independent contractor for multiple lenders to close on Refinances, Loan Modifications, Heloc and Reverse Mortgages. I am also approved with the State of Tennessee to do Remote closes via computer meetings.Parallon, Nashville, TNTransaction Specialist04/2017- 09/2019 Apply payments correctly to accounts to ensure accurate statement of accounts receivable. Document accounts accurately for further actions needed. Ensure accounts are written off in accordance to company policy in a timely manner. Review and make sure accounts are correctly tracking balances to patient or Insurance for correct follow-up. Submit plines to ensure accounts are tracking the correct balance for either insurance responsibility or patient responsibility.Build client profiles in Healthaxis, medicalHealthSCOPE Benefits, Nashville, TNBenefits Programmer 03/2017- Present Work closely with new client case manager to determine the benefits specific to their requests Build client profiles in Healthaxis, medical routine tables, member tables, and EOB tables Create code language (Auto pay rules) to dictate how benefits will pay or deny, to be loaded intoHealthaxis database, as well as adding coding to process ICD-10, CPT codes, and Surgical codes specific to client benefits and ensure that code language works through compliance testing Wellmark BC/BS, Des Moines, IALead Specialist-Blue Card Host 04/2007 03/2017 Train and assist staff members regarding claim processing in the Blue II system and in Compass Assist with changes in existing and in the development of new guidelines for claim processing Assist new hires in training as a subject matter expert on claims processing Ability to adjust to each employees learning style and needs Assist supervisor with the work distribution for the day and monitor aging using Excel spreadsheets Provide team leader with updates regarding employee issues, concerns, and training Research efficient ways to use existing systems to improve workflow Create new macros for work distribution and new edits Quality Assurance Specialist-High Dollar Claims III Provided quality assurance reviews for all lines of business for claims with high dollar amounts from entry to finalization Adjusted claims using Compass system Assigned daily work distribution for staff Coded and worked Transplant claims Assisted team with pricing improvement and finding a solution to problem areas Claims Examiner II Adjusted claims that needed corrections to processing or suspended for various edits Worked with coordination of benefits and WHPI*Please note employment from 1980 1987 was also at Blue Cross Blue Shield Hy-Vee Care, Urbandale, IA 10/2006 - 04/2007 Prior Authorization Facilitated authorization for patients medications through Medicare D and Medicaid plans Called on nursing homes and doctor offices for medication approvals for patients as needed Assured claims were processed for payment correctly and to have them adjusted as needed by patients insurance Offered suggestions to patients from the pharmacist to change prescription to a preferred medication if needed Assisted in filling prescriptions in the pharmacy Wells Fargo Financial, Urbandale, IA 07/2006-10/2006 Backend Collector Contacted customers concerning nonpayment of credit card and consumer loans Worked with customers on payment arrangements or programs to ensure current payment status Tennessee Sports Medicine & Orthopedics, Mt Juliet, TN 9/2005-07/2006 Patient Accounts Corresponded with various insurance companies to ensure claims were processed timely Review coding and correct issues prior to claim processing Transferred medical records to insurancePRIOR WORK EXPERIENCE:HCA Healthcare, Donnellson, TN 8/2002-6/2005 Discrepancy Analyst University Medical Center, Lebanon, TN 4/2001-8/2002 Unit Secretary Patient RepresentativeCleaning Business, Urbandale, IA 1999-2001 Owner/ Partner Urbandale Public Library, Urbandale, IA 1997-1999 Librarian Page/Assistant Veteran's Hospital, Des Moines, IA 1990-1993 Medical Transcriptionist Data Input Services, Des Moines, IA 1988-1990 Data Entry Clerk* Blue Cross & Blue Shield of Iowa, Des Moines, IA 1980-1987 Claims Examiner/Adjuster Education:DMACC, Ankeny, IAClerical and Word data processing Certificate |
