health management sr specialist resume example with 20+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
:
Summary
OBJECTIVE: To successfully obtain the position of Claims Processing Support Analyst I. Hardworking and reliable Senior Specialist with strong ability in being analytical and detailed. Offering problem solving skills, MS word and excel and attention to detail. Highly organized, proactive and punctual with team-oriented mentality.
Skills
Ability to analyze reports
Quantitative skills
Flexible
Conflict resolution
Work ethic
Computer skills
Experience
Health Management Sr. Specialist, 07/2008 - Current Otter Tail Corporation – Otsego, MN,
Generating Crystal reports to create an audit list for concurrent utilization review program hospitals.
Create shells for audit patients in audit database
Load hospital records for all audit samples
Requesting refunds on claims paid incorrectly for non-covered services.
Recovered over $500,000 for company.
Working appeals submitted by providers.
Initiating project management skills to achieve daily work goals.
Training individuals on generating crystal report.
Sending written correspondence to providers that reflect appeal decisions.
Talking to customers by phone regarding appeal requests.
Assisting other areas with the understanding and reading of Jiva to ensure claims process correctly.
Handle employee contracts for area.
Customer Account Representative, 02/2004 - 07/2008 Kaiser Permanente – Clovis, CA,
Maintained accurate and current eligibility files of subscriber information.
Audited billing information for groups.
Maintained accuracy with enrollment information for over 1000 groups.
Requested ID cards for new employees.
Provided excellent customer service to customers and employees.
Worked closely with Customer Service, Marketing and Underwriting to ensure that customer files were accurate and updated as needed.
Worked on special projects in Excel to balance accounts for customers.
Reviewed accounts for delinquencies and other ongoing issues.
Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
Inquiry Analyst, 12/2000 - 02/2004 Blue Cross And Blue Shield Of Alabama – City, STATE,
Provided various services to our customers in a timely and courteous fashion.
Investigated inquiries concerning benefits to determine if benefits were provided correctly.
Compiled and researched data to gather facts used to perform all necessary refunds and adjustments.
Worked closely with Customer Service, Claims and Medical Review.
Received Crystal training.
Claims Examiner, 05/1998 - 12/2000 Blue Cross And Blue Shield Of Alabama – City, STATE,
Responsible for processing all Blue Cross, Blue Shield and Major Medical claims.
Ensured payments were made accurately and in a timely manner.
Worked closely with other areas within the company such as Medical Review, Subscriber Contracts Administration, and Customer Accounts.
Paid and processed claims within designated authority level.
Reviewed claims to ensure accuracy, resulting in multiple claim reductions.
Researched and followed up on denied insurance claims.
Analyzed and audited open claims to calculate additional payments owed.
Education and Training
Master’s degree: Healthcare Management, Expected in 2006 - University of Phoenix - , GPA: Status -
Bachelor of Science: Finance degree, Expected in 2001 - University of Alabama - Birmingham, GPA: Status -
Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.