Objective: To obtain a position within the Health Industry in order to maximize my skills in the Quality Assurance, Customer Service, and Claims Examining skills.
Remington College Criminal Justice 2000-2001
Everest College Criminal Justice 2002-2003
Schumacher Group - February 2011 - January 2012 - Quality Assurance/Reporting Analyst II
• Complete high level reports and audits to ensure company is running properly daily. Provide management with daily volume of claims and statements extracted from TES to Bar, including categorization, and daily monetary cash balances.
• Provide and participate in performance training of employees. Recommend employee improvements, write step by step Policy & Procedures for selected departments, provide employee coaching, and report errors to supervisors weekly.
• Perform daily analysis ensuring all electronic claims have been submitted and accepted by all payers. Provide weekly trending reports to upper management advising of accepted and rejects with explanation.
• Audit Collections Dept to ensure proper protocol was taken when recalling accounts. Research and complete all return accounts from collection agencies and report results. Audit/Train Edits Teams to ensure proper protocol was taken when prepping claims for payment.
• Distribute daily snapshot of all functions throughout company and all subsidiaries to Executive Management team.
Dell Perot Systems - January 09 - January 11 - Kaiser Permanente CSR/Claims Examiner/Trainer
• Verify, key, and process submitted Medicaid, CHIP Perinate, and Physical Therapy UB92 and HCFA claims according current and relevant State Rules and Regulations.
• Exceed production averages and accuracy minimums for payments and denials.
• Communicate with providers and members through clear and concise correspondence.
• Monitor and follow up on pending claim activity requiring additional information timely and accurately.
• Take inbound member, client, and broker calls. Enforce HIPPA laws with each phone call and claim processed.
• Audit accounts to ensure correct information was received. Make necessary corrections and request additional information if required. Verify and update plan member information. Ensure claims are processed according to each contract.
• Explain Explanation of Benefits/Schedule of Coverage, advise members/providers of deductible/out of pocket accumulations. Aid in medical/prescription authorization approvals.
• Train and provide coaching to incoming employees.
Various Temporary Agencies - April 08 - December 08 - Various Positions
• Kelly Services (Cigna) - April 08 - July 08 - Claims Examiner
o Verify, key, and audit Workers Compensations claims for all 50 states based on Rules and Regulations. Determine that each incident is a work related prior to payment or denial. Correspond with providers via telephone and written/automated generated letters as needed. Maintain speed, accuracy, and turnaround time.
• Progressive Staffing (Ameripath) - August 08 - August 08 - Data Entry Operator
o Accurately key laboratory bills in a production based environment. Maintain departmental standards and accuracy.
• Progressive Staffing (Michael‘s Corporate Office) - September 08 - October 08 - Administrative Assistant
o Create reports and spreadsheets based on in store surveys relating to store activity and appearance.
• WorkWay (CititMortgage) - October 08 - December 08 - Title Curative Specialist
o Complete title exams to be delivered to attorney and follow up to resolve any non-legal issues regarding title search. Obtain lien releases, contact various sources to research, verify, resolve title issues, and file title claims.
Injury Management Organization - October 07 - March 08 - Claims Examiner/Trainer
• Verify, key, and audit all incoming claims based on the State of Texas Workers Compensation Rules and Regulations.
• Correspond with providers via telephone or mail regarding payments and denials.
• Process specialty claims and accounts.
• Train, audit, and coach incoming employees.
• Maintain all accuracy guidelines set by management, meet all deadlines, and turnaround times.
Concentra Integrated - January 05 - July 07 - Claims Examiner
• Verify, key, and audit Workers Compensation Claims for according to TX/ FL Rules and Regulations.
• Determine that each claim is in response to a true work related incident
• Contact providers as needed via telephone or written correspondence.
• Train, audit, and coach incoming employees.
• Maintain speed, accuracy, and turnaround time on each claim.
10 Key By Touch, 50 wpm, ICD9, HCFA, UB92, CPT Codes, Medical Terminology, Analytical, Attentive to Detail, Strong Interpersonal Skills, Excellent Written and Verbal Skills, Superb Customer Skills and Etiquette, Knowledgeable of HIPPA Guidelines Medicare, Medicaid, Commercial Medical, Workers Compensation
IDX, PBI, Centricity, Centricity EDI, Salesforce, Excel (Pivot Tables, Formulas, and V Lookup) Diamond, Power Trak, QNXT, Macess, Resolve It, Word, Access, Power Point, Lotus Notes, Citrix, Internet Proficient