Experience

Lumeris

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Business System Analyst

  • May 2019 - Present



Centene Corporation

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Claims Liaison II

  • Oct 2018 - May 2019



Lumeris

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Claims Analyst

  • 2017 - Oct 2018

  Maryland Heights, MO As a Claims Analyst, my duties include processing complex claims including, but not limited to hospice, clinical trials, pricing, and non-par claims. Handles direct member reimbursement requests, claim reports, and client specific specialty claims as well as the overpayment process. Reviews provider contracts to ensure accurate processing. Identifies and responds to potential system and process issues appropriately and timely. Handles provider pay disputes and adjustment requests. Performs… Show more As a Claims Analyst, my duties include processing complex claims including, but not limited to hospice, clinical trials, pricing, and non-par claims. Handles direct member reimbursement requests, claim reports, and client specific specialty claims as well as the overpayment process. Reviews provider contracts to ensure accurate processing. Identifies and responds to potential system and process issues appropriately and timely. Handles provider pay disputes and adjustment requests. Performs provider and member outreach as necessary. Utilizes internal and external applications and resources, such as EncoderPro, CES, and Medicare’s pricers.

• Senior Claims Processor

  • 2016 - 2017

  Maryland Heights, MO As a Senior Claims Processor, my duties included processing mid-level complexity claims including, but not limited to COB, pricing modifiers, and interim billing. Processed paper and electronic corrected claims as well as adjustment requests. Utilized guides and resource documents to ensure proper processing of claims.

• Customer Service Representative

  • 2015 - 2016

  Maryland Heights, MO As a Customer Service Representative, my duties included answering member and provider phone calls regarding various topics ranging from eligibility and benefits to general claims status, worked with other departments within the company as well as external entities, relayed benefit information, and resolved/responded to simple and complex member and provider issues.



Concero

• United States
• Staffing and Recruiting
• 1 - 100 Employee

• Benefits Specialist

  • 2015 - 2015

  Maryland Heights, MO As a temporary sales assistant assigned to Essence Healthcare, my duties included answering broker and customer phone calls, data entry of broker enrollment applications, call documentation, setting appointments, answering perspective members' benefit questions, and any additional duties as assigned.