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Claims-Medicare Secondary Payer Processor Senior Resume Example

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CLAIMS-MEDICARE SECONDARY PAYER PROCESSOR SENIOR
Professional Summary

Experienced Claims-Medicare Secondary Payer professional with strong leadership and relationship-building skills

Experienced Claims-Medicare Secondary Payer professional with strong leadership and relationship-building skills.

Experienced Claims-Medicare Secondary Payer professional with strong leadership and relationship-building skills.

Experienced Claims-Medicare Secondary Payer professional with strong leadership and relationship-building skills and a driven focus on process implementation and continued efficiency.

Experienced Senior Claims-Medicare Secondary Payer professional processor with strong leadership and relationship-building skills and a driven focus on process implementation and continued efficiency.

Skills

Team leadership

  • Self-motivated
  • Strong verbal communication
  • Data management
  • Process implementation
  • Conflict resolution
  • Team liaison
  • Team leadership
  • Self-motivated
  • Strong verbal communication
  • Data management
  • Conflict resolution
  • Team liaison
  • Process implementation
  • Critical Thinker
  • Team leadership
  • Self-motivated
  • Strong verbal communication
  • Data management
  • Telecommuter Experience
  • Conflict resolution
  • Team liaison
  • Process implementation
  • Critical Thinker
  • Team leadership
  • Self-motivated
  • Strong verbal communication
  • Data management
  • Telecommuter Experience
  • Conflict resolution
  • Team liaison
  • Process implementation
  • Critical Thinker
Professional Work History
Claims-Medicare Secondary Payer Processor Senior, 10/2015 to Current
Blue Shield of California – El Dorado Hills, California
  • Conducts daily team meetings to maintain a sense of consistent communication and inventory with process progression 
  • Processes claims and claim-related correspondence for the Medicare Secondary Payer process
  •  Develops and maintains PDF work-around documents for representatives to use when completing a certain task or case 
  • Examines specific claims to determine and resolve any issues there may be in a timely manner 
  •  Conducts daily phone calls with outside contracted companies and collection agencies to ensure claims are being examined and processed appropriately by all parties involved 
Claims-Medicare Secondary Payer Processor Senior, 10/2015 to Current
Blue Shield of California – El Dorado Hills, California
  • Conducts daily team meetings to maintain a sense of consistent communication and inventory with a focus in process progression. 
  • Processes claims and claim-related correspondence for the Medicare Secondary Payer process.
  • Develops and maintains PDF work-around documents for representatives to use when completing a certain task or case. 
  • Examines specific claims to determine and resolve any issues there may be in a timely manner. 
  • Conducts daily phone calls with outside contracted companies and collection agencies to ensure claims are being examined and processed appropriately by all parties involved.
  • Strong communication partnerships with multiple departments within Blue Shield.
  • Obtains documents and clearances from local, state and federal agencies or employer groups.
Claims-Medicare Secondary Payer Processor Senior, 10/2015 to Current
Blue Shield of California – El Dorado Hills, California
  • Conducts daily team meetings to maintain a sense of consistent communication and inventory with a focus in process progression. 
  • Processes claims and claim-related correspondence for the Medicare Secondary Payer process.
  • Develops and maintains PDF work-around documents for representatives to use when completing a certain task or case. 
  • Examines specific claims to determine and resolve any issues there may be in a timely manner. 
  • Conducts daily phone calls with outside contracted companies and collection agencies to ensure claims are being examined and processed appropriately, by all parties involved.
  • Strong communication partnerships with multipledepartments within Blue Shield of California.
  • Obtains documents and clearances from local, state and federal agencies or employer groups.
  • Manages all Medicare Secondary Payer inventory and reports data to upper management on a daily basis.
Claims-Medicare Secondary Payer Processor Senior, 10/2015 to Current
Blue Shield of California – El Dorado Hills, California
  • Conducts daily team meetings to maintain a sense of consistent communication and inventory with a focus in process progression. 
  • Processes claims and claim-related correspondence for the Medicare Secondary Payer process.
  • Develops and maintains PDF work-around documents for representatives to use when completing a certain task or case. 
  • Examines specific claims and/or claim-related problems to determine and resolve any issues that may arise in timely manner. 
  • Conducts daily phone calls with outside contracted companies and collection agencies to ensure claims are examined and processed appropriately, by all parties involved.
  • Strong communication partnerships with multiple departments within Blue Shield of California.
  • Obtains documents and clearances from local, state and federal agencies or employer groups.
  • Manages all Medicare Secondary Payer inventory and reports data to upper management on a daily basis.
Claims-Medicare Secondary Payer Processor Senior, 10/2015 to Current
Blue Shield of California – El Dorado Hills, California
  • Conducts daily team meetings to maintain a sense of consistent communication and inventory with a focus in process progression. 
  • Currently leading a team of Medicare Secondary Payer processors  to not only ensure daily process resolution, but also answer any question or concerns that each processor may have.
  • Processes claims and claim-related correspondence for the Medicare Secondary Payer process.
  • Develops and maintains PDF work-around documents for representatives to use when completing a certain task or case. 
  • Examines specific claims and/or claim-related problems to determine and resolve any issues that may arise in timely manner. 
  • Conducts daily phone calls with outside contracted companies and collection agencies to ensure claims are examined and processed appropriately, by all parties involved.
  • Strong communication partnerships with multiple departments within Blue Shield of California.
  • Obtains documents and clearances from local, state and federal agencies or employer groups.
  • Manages all Medicare Secondary Payer inventory and reports data to upper management on a daily basis.
Claims-Medicare Secondary Payer Processor Senior, 10/2015 to Current
Blue Shield of California – El Dorado Hills, California
  • Conducts daily team meetings to maintain a sense of consistent communication and inventory with a focus in process progression and inventory management.
  • Currently leading a team of Medicare Secondary Payer processors to not only ensure daily process resolution, but also answer any questions or concerns that may arise.
  • Processes claims and claim-related correspondence for the Medicare Secondary Payer process.
  • Develops and maintains PDF work-around documents and DLP's for representatives to use when completing a certain task or case. 
  • Examines specific claims and/or claim-related problems to determine and resolve any issues that may arise in a timely manner. 
  • Conducts daily phone calls with outside companies and collection agencies to ensure claims are examined and processed appropriately, by all parties involved.
  • Strong communication partnerships with multiple departments and varied levels of management within Blue Shield of California.
  • Obtains documents and clearances from local, state and federal agencies or employer groups.
  • Manages all Medicare Secondary Payer inventory and reports data to upper management on a daily basis.
  • Fluent knowledge of other claim processes, including: Medicare Advantage, Commercial professional and Facility. 
Claims-Medicare Secondary Payer Processor Senior, 10/2015 to Current
Blue Shield of California – El Dorado Hills, California
  • Conducts daily team meetings to maintain a sense of consistent communication and inventory with a focus in process progression. 
  • Processes claims and claim-related correspondence for the Medicare Secondary Payer process.
  • Develops and maintains PDF work-around documents for representatives to use when completing a certain task or case. 
  • Examines specific claims to determine and resolve any issues there may be in a timely manner. 
  • Conducts daily phone calls with outside contracted companies and collection agencies to ensure claims are being examined and processed appropriately, by all parties involved.
  • Strong communication partnerships with multiple departments within Blue Shield of California.
  • Obtains documents and clearances from local, state and federal agencies or employer groups.
  • Manages all Medicare Secondary Payer inventory and reports data to upper management on a daily basis.
Clinical Support Coordinator Senior, 08/2014 to 10/2015
Blue Shield of California – El Dorado Hills, California
  • Efficiently and accurately documented authorizations and Inquiries.
  • assisted with and helped guide provider-related authorizations on a day-to-day basis.
  • Cross-trained in all aspects of the Clinical Support Coordinator role, including Medicare, Prior Authorization, and Commercial Lines of Business.
  • Consistently assisted with clinical and non-clinical staff to resolve prior authorization or case management issues to ensure the member could receive appropriate services in a timely manner.
  • Developed training curriculum and materials for specific one-on-one training.
Clinical Support Coordinator Senior, 08/2014 to 10/2015
Blue Shield of California – El Dorado Hills, California
  • Efficiently and accurately documented authorizations and Inquiries with providers via telephone and facsimile. 
  • Cross-trained in all aspects of the Clinical Support Coordinator role, including Medicare, Prior Authorization, and Commercial Lines of Business.
  •  Assisted with clinical and non-clinical staff to resolve prior authorization or case management issues to ensure the member could receive appropriate services in a timely manner.
  • Developed training curriculum and materials for specific one-on-one training with other coordinators. 
  • Consistently scored in the high-production percentile range for facsimiles processed.
Clinical Support Coordinator Senior, 08/2014 to 10/2015
Blue Shield of California – El Dorado Hills, California
  • Efficiently and accurately documented authorizations and Inquiries.
  • Assisted with and helped guide provider-related authorizations on a day-to-day basis.
  • Cross-trained in all aspects of the Clinical Support Coordinator role, including Medicare, Prior Authorization, and Commercial Lines of Business.
  • Consistently assisted with clinical and non-clinical staff to resolve prior authorization or case management issues to ensure the member could receive appropriate services in a timely manner.
  • Developed training curriculum and materials for specific one-on-one training.
Clinical Support Coordinator Senior, 08/2014 to 10/2015
Blue Shield of California – El Dorado Hills, California
  • Efficiently and accurately documented authorizations and Inquiries.
  • assisted with and helped guide provider-related authorizations on a day-to-day basis.
  • Cross-trained in all aspects of the Clinical Support Coordinator role, including Medicare, Prior Authorization, and Commercial Lines of Business.
  • Consistently assisted with clinical and non-clinical staff to resolve prior authorization or case management issues to ensure the member could receive appropriate services in a timely manner.
  • Developed training curriculum and materials for specific one-on-one training.
  • Promoted to Senior title within one year of work as  Clinical Support Coordinator. 
Clinical Support Coordinator Senior, 08/2014 to 10/2015
Blue Shield of California – El Dorado Hills, California
  • Efficiently and accurately documented authorizations and Inquiries.
  • assisted with and helped guide provider-related authorizations on a day-to-day basis.
  • Cross-trained in all aspects of the Clinical Support Coordinator role, including Medicare, Prior Authorization, and Commercial Lines of Business.
  • Consistently assisted with clinical and non-clinical staff to resolve prior authorization or case management issues.
  • Developed training curriculum and materials for specific one-on-one training.
  • Promoted to Senior title within one year of work as  Clinical Support Coordinator. 
Clinical Support Coordinator Senior, 08/2014 to 10/2015
Blue Shield of California – El Dorado Hills, California
  • Efficiently and accurately documented authorizations and Inquiries
  • assisted with and helped guide provider-related authorizations on a day-to-day basis
  • Cross-trained in all aspects of the Clinical Support Coordinator role, including Medicare, Prior Authorization, and Commercial Lines of Business
  • Consistently assisted with clinical and non-clinical staff to resolve prior authorization or case management issues
  • Developed training curriculum and materials for specific one-on-one training.
Meat Clerk, 02/2013 to 08/2014
WinCo Foods – Folsom, California
  • Provided excellent customer service to every customer, every time Eager to assist with any tasks using a professional and courteous attitude Interacted with local meat managers and customers to assist with questions and orders Determined and compiled daily orders for product Ensured quality of the food products, in both front-end and back-room areas Assisted in the preparation of cut meats Rotated inventory to maintain quality and determined price adjustments as appropriate.
Meat Clerk, 02/2013 to 08/2014
WinCo Foods – Folsom, California
  • Interacted with local meat managers and customers to assist with questions and orders 
  • Assisted in the preparation & handling of cut-meats 
  • Refilled and rotated items on shelves to maintain well-stocked inventory.
  • Followed proper standards for product freshness, food safety, weights and measures, refrigeration and sanitation.
  • Prepared and maintained daily inventory records.
  • Maintained an atmosphere of enthusiastic customer service.
Meat Clerk, 02/2013 to 08/2014
WinCo Foods – Folsom, California
  • Interacted with local meat managers and customers to assist with questions and orders. 
  • Assisted in the preparation and  handling of cut-meats. 
  • Refilled and rotated items on shelves to maintain a well-stocked inventory.
  • Followed proper standards for product freshness, food safety, weights and measurements, refrigeration and sanitation.
  • Prepared and maintained daily inventory records.
  • Maintained an atmosphere of enthusiastic customer service on a daily basis.
Meat Clerk, 02/2013 to 08/2014
WinCo Foods – WinCo Foods, California
  • Interacted with local meat managers and customers to assist with questions and orders. 
  • Assisted in the preparation and  handling of cut-meats. 
  • Refilled and rotated items on shelves to maintain a well-stocked inventory.
  • Followed proper standards for product freshness, food safety, weights & measurements, refrigeration and sanitation.
  • Prepared and maintained daily inventory records.
  • Maintained an atmosphere of enthusiastic customer service on a daily basis.
Meat Clerk, 02/2013 to 08/2014
WinCo Foods – Folsom, California
  • Interacted with local meat managers and customers to assist with questions and orders. 
  • Assisted in the preparation and  handling of cut-meats. 
  • Refilled and rotated items on shelves to maintain well-stocked inventory.
  • Followed proper standards for product freshness, food safety, weights and measures, refrigeration and sanitation.
  • Prepared and maintained daily inventory records.
  • Maintained an atmosphere of enthusiastic customer service on a daily basis.
Production Team Member, 03/2012 to 12/2012
Target stores – Redwood City, California
  • Sorted all store merchandise and ensured accurate department placement.
  • Rotated inventory based on quality and stock list.
  • Maintained a clean display of product on all shelves within the store at all times.
  • Ensured store cleanliness and safety for all customers.
  • Worked efficiently in order to meet daily and weekly project or production goals.
  • Observed and followed all safety policies and procedures to ensure overall safety for employees and store management. 
  • Closely inspected line partsto ensure they were clean and free of contaminants on a consistent basis. 
Production Team Member, 03/2012 to 12/2012
Target stores – Redwood City, California
  • Sorted all store merchandise and ensured accurate department placement.
  • Rotated inventory based on quality and stock list.
  • Maintained a clean display of product on all shelves within the store.
  • Ensured store cleanliness and safety for all customers.
  • Worked efficiently in order to meet daily, weekly, project or production goals.
  • Observed and followed all safety policies and procedures to ensure overall safety for employees and store management. 
  • Closely inspected line parts to ensure they were clean and free of contaminants.
Production Team Member, 03/2012 to 12/2012
Target stores – Redwood City, California
  •  Sorting of store merchandise and ensuring accurate department placement.
  • Rotated inventory based on quality and stock list.
  •  Maintained a clean display of product on all shelves within the store.
  • Ensured store cleanliness and safety for all customers
  • Planned and paced work efficiently in order to meet daily, weekly, project or production goals.
  • Observed and followed all safety policies and procedures.
Cashier/Customer Service Representative, 01/2011 to 01/2012
Hy-Vee Foods – West Des Moines, Iowa
  • Promoted from a general clerk position to customer service/cashier in 6 months Listened to customers' needs and provided appropriate assistance Neatly stocked and organized grocery shelves and operated the cash register with accuracy Excellent work attendance and professional attitude Ensured the store was clean and safe for customers and employees.
Customer Service Representative, 01/2011 to 12/2011
Hy-Vee Foods – West Des Moines, Iowa
  • Promoted from a general clerk position to customer service/cashier within six months of employment. 
  • Listened to customers' needs and provided appropriate assistance on a daily basis.
  • Operated the cash registers with accuracy & efficiency
  • Excellent work attendance and professional attitude
  • Ensured the store was clean and safe for customers and employees.
  • Reviewed & managed back-room inventory on a daily basis for foods and beverages.
  • Answered product questions with up-to-date knowledge of sales and store promotions.
  • Developed a reputation as an efficient service provider with high levels of accuracy.
Customer Service Representative, 01/2011 to 12/2011
Hy-Vee Foods – West Des Moines, Iowa
  • Operated the cash registers with accuracy & efficiency on a daily basis with a heightened emphasis on dollar count and security. 
  • Excellent work attendance and professional attitude on a constant basis. 
  • Ensured the store was clean and safe for all customers and employees.
  • Reviewed & managed back-room inventory on a daily basis for different store-related products.
  • Answered product questions with up-to-date knowledge of sales and store promotions.
  • Developed a reputation as an efficient service provider with high levels of accuracy.
  • Conducted weekly walk-through's with management to discuss interior visual displays, including store window presentation.
  • Investigated and resolved customer inquiries and complaints in a timely and empathetic manner.
Additional Skills
  • Computer Proficiency
      - Extremely Proficient in a variety of computer programs including; Microsoft Excel (extensive knowledge and usage of Excel) , Power Point & Word applications to develop inventory tracking, document creation and presentations.

         - Proficient in a plethora of Blue Shield-specific applications, including but not limited to; multiple applications within Facets, (including Utilization Management, Supervisor Dashboard, Claims Processing, Customer Service and Coordination of Benefits), DocDNA, ERM, Tableau, Business Objects and more.

 

  • Effective Communication
      -Daily email, phone & in-person communication with supervisors, managers and directors from different internal departments to ensure process efficiency and case resolution. 

        -Proficient in creating & leading one-one-one and/or team meetings with strong Web-Ex and meeting scheduler skills.

  • Computer Proficiency
      -Continually uses Microsoft Excel, Power Point & Word applications to develop inventory tracking, create documents and produce presentations
  • Effective Communication
      -Daily email, phone & in-person communication with supervisors, managers and directors from multiple areas within the company to ensure process efficiency and case resolution
Accomplishments
  • Received the highest Blue Shield of California performance rating for 2017 year-end review
  • Recipient of the 2016 Spot Bonus award for Quarter 3 accomplishments & commitments to the Medicare Secondary Payer Process
  • Received employee of the month during January of 2015
  • Received the highest Blue Shield of California performance rating for 2017 year-end review.
  • Recipient of the 2016 Spot Bonus award for Quarter 3 accomplishments & commitments to the Medicare Secondary Payer Process.
  • Received employee of the month during January of 2015.
  • Reduced the overall Medicare Secondary Payer debt demand letter inventory from over 600 cases during first quarter of 2017 to under 100 cases by first quarter of 2018.  
Education
Bachelor of Science: Business Administration , Present
Trident University -
  • Focus in Entrepreneurship
B.S.B.A: Entrepreneurship, Present
Trident University -

Entrepreneurship

Bachelor of Science: Business Administration , Present
Trident University -
  • Focus in Entrepreneurship
High School diploma: June 2012
Delta Pacific Charter School - Tracy, CA
High School Diploma: June 2012
Delta Pacific Charter School -
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Resume Overview

Companies Worked For:

  • Blue Shield of California
  • WinCo Foods
  • Target stores
  • Hy-Vee Foods

School Attended

  • Trident University
  • Delta Pacific Charter School

Job Titles Held:

  • Claims-Medicare Secondary Payer Processor Senior
  • Clinical Support Coordinator Senior
  • Meat Clerk
  • Production Team Member
  • Cashier/Customer Service Representative
  • Customer Service Representative

Degrees

  • Bachelor of Science : Business Administration , Present
    B.S.B.A : Entrepreneurship , Present
    Bachelor of Science : Business Administration , Present
    High School diploma : June 2012
    High School Diploma : June 2012

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