Question/resume

Summary of Skills

· Professional, responsible with proven customer service skills

· Experience in auditing, support, assessment and duties involved billing

· Customer interaction, Case management and organizational skills

· Responsibility for client caseloads and the privacy Usage of proper practice, procedure and intervention.

Education

Associates Degree: Health Information Management; Graduation 05/2012, Bachelor Degree: Sociology and Christian Studies, Graduation Date: 10/2015, Masters: Graduate Studies, Professional Psychology, Graduation: 2019

Experience

Insight Global /Superior HealthPlan 09/2017–04/2018

Provider Services

· Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters.

· Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries

· Document all activities for quality and metrics reporting through the Customer Relationship. Management (CRM) application 

· Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment

Omnicare Pharmacy 07/2015 – 03/2016

Billing Specialist

· Prepared and examined daily financial billing records. Ensured that financial records were accurate and that accounts were paid properly and on time.

· Verified insurances and maintained all accounts receivables for facility and /or private pay.

· Reviews private pay billing statements for correctness and accuracy of charges, reviewed for misstatement, billing in compliance, review errors, reports, practices

· Prepared billing correspondence, including notices, denial, discrepancies and payments,

· Perform census of all assisted living facilities, reviewed new patient submission to make sure all information is correct received Assures timely, accurate billing of patient describe medications

Public Health and Prevention Specialist 02/2014- 06/2015

Health & Human Services Commission

Texas Work Advisor II Case Management

· Performed eligibility determinations, based on requirements for state benefits

· Evaluates applicant’s eligibility, case management

· Researched additional resources, for food, shelter, and clinics

· Advocate and workings along-side affiliated agencies and service recipients

TruGreen Lawn Care 03/2004 – 06-2007

Billing and Audit Specialist

· Daily review internal accounts to ensure the validity and legality of the offices financial records.

· Regularly monitored potential billing issues for any overcharges and or mistakes

· Responsible for validating of claims payments according to contractual terms in all pertinent agreements, which requires knowledge of contractual agreements. 

· Understanding of alternative Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.