Medicare Part B Representative Resume Example Amerihealth Caritas Health Plan

MEDICARE PART B REPRESENTATIVE

Professional Summary

Skills

Work History

Medicare Part B Representative10/2019 to Current
Amerihealth Caritas Health Plan – Toledo , OH

Answer incoming phone calls from providers to identify the type of assistance needed (i.e.
Benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs).
Secures medical necessity checks/verification in accordance to Centers for Medicare & Medicaid services, verifies insurance, benefits, coverage and eligibility.
Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries' entitlement.
Research complex issues across multiple databases and work with support resources to resolve customer issues and / or partner with others to resolve escalated issues.
Maintain accurate enrollment for assigned clients, troubleshoot and resolve issues as they arise.
Conduct all work in accordance with the confidentiality requirements mandated by HIPAA for member information.
Maintain and understand of all internal and external computer systems and reports that impact the enrollment process.

Senior Financial Customer Consultant Specialist09/2016 to 04/2019
Voya – City , STATE

Support of Custom Money-Out processing for participant plans.
Responsible for manual transactions issued through the contact center as well as: Distribution Sweeps, Excess Contributions, Installments, Non-Qualified Transactions, RMD, Roth Rollovers, etc.
Support of internal compliance monitoring aggregation system and automated contribution file processing for plan sponsors.
Process includes plan set-up, plan maintenance, and file processing.
Quality review of financial and non-financial transactions processed by the various processing teams.
Responds to client requests for information.
Resolves client administrative or service problems.
Ensures that all transactions are processed according to the company's and the client's standards.
Processes transactions to complete plan valuation such as contributions, loans, withdrawals, and earnings allocations.
Formats and loads data.
Review distribution request documents and process transaction per the request of plan participants based on plan rules and/or direction of sponsor or TPA.
Provides product and service information to agents and customers.
Resolve product and service problems by clarifying customer's complaints.
Maintains customer records by updating account information.
Maintains financial accounts by processing customer adjustments.
Verify security of callers to eliminate possibility of fraud.
Facilitate team huddles and Root Cause Problem Solving meetings.

Provider Enrollment Specialist04/2013 to 05/2014
First Coast Service Options – City , STATE

Accomplish daily enrollment/ disenrollment operations, including application review, entering applications into system and submissions in CMS.
Obtain missing information for enrollment completion.
Maintain accurate enrollment for assigned clients, troubleshoot and resolve issues as they arise.
Analyze multiple report from various sources to determine and implement appropriate action to reconcile enrollment discrepancies.
Conduct research as necessary to effectively resolve client's issues and respond to inquiries in a timely manner.
Courteously provide client with information and education concerning government program enrollment processes and requirements.
Utilized state enrollment systems and managed care enrollment systems.
Conduct all work in accordance with the confidentiality requirements mandated by HIPAA for member information.
Completed credentialing applications for providers.
Maintain and understand of all internal and external computer systems and reports that impact the enrollment process.

Administrative Assistant/Head Counselor/Supervisor01/1999 to 06/2012
Saint Francis Xavier Youth Program – City , STATE

Manage, Instruct, and Supervise 6+ employees.
Provide administrative support including answering phone, recordkeeping, managing incoming or outgoing mail and fax.
Managed the day-to-day calendar for all program services.
Drafted and Transcribed letter to various corporations and programs.
Setup community service activities for participants of Youth Program.
Provide appropriate direction of children/youth in their daily routine.
Construct daily and long-term schedules of activities that promote intellectual and physical development.
Improve children/youth language development, social skills, and understanding of scientific and mathematical concepts by using children's play, such as story telling and games.
Serve as Supply Officer for General office and Program needs.
Reputation for dependability, honesty, dedication and enthusiasm.

Education

Murry Bergtraum High School For Business Careers- City, State

Some College (No Degree): Arts, Early Childhood EducationFlorida State College At Jacksonville- City, State

Accomplishments

Additional Information

Certifications

Series 6 Licencse

Resume Overview

School Attended

Job Titles Held:

Degrees