Experience

Anthem

• United States
• Insurance
• 700 & Above Employee

• Member Service Rep II

  • Sep 2013 - Present

  Responsible for processing enrollments and billing activities for SHBP of GA. Verify enrollment status, make changes to records, and research and resolve enrollment system rejections within WGS. Perform weekly peer to peer audits. Work closely with the State of GA representatives to ensure accuracy and timeliness. Perform updates within ESI to ensure benefit dollars are properly assigned to the employee’s account. Work closely with claims to ensure proper assignments of COBs. Responsible for processing enrollments and billing activities for SHBP of GA. Verify enrollment status, make changes to records, and research and resolve enrollment system rejections within WGS. Perform weekly peer to peer audits. Work closely with the State of GA representatives to ensure accuracy and timeliness. Perform updates within ESI to ensure benefit dollars are properly assigned to the employee’s account. Work closely with claims to ensure proper assignments of COBs.



Aspirion

• United States
• Hospitals and Health Care
• 200 - 300 Employee

• Claim Specialist

  • Apr 2009 - Sep 2012

  Managed several hospital accounts across the Southeast and acted as a liaison between patients, attorneys, healthcare providers, insurance carriers and government agencies. Filed claims with appropriate insurance carriers for payment for medical services rendered. Conducted month end audits on Worker Compensation denials and appeals, case management assignments, confirmed policy coverage, filed and recovered Worker Compensation reimbursement. Managed several hospital accounts across the Southeast and acted as a liaison between patients, attorneys, healthcare providers, insurance carriers and government agencies. Filed claims with appropriate insurance carriers for payment for medical services rendered. Conducted month end audits on Worker Compensation denials and appeals, case management assignments, confirmed policy coverage, filed and recovered Worker Compensation reimbursement.



Via Health

• Hospitals and Health Care
• 1 - 100 Employee

• PATIENT LIAISON

  • Mar 2007 - Oct 2008

  Handled incoming calls, worked closely with providers and patients to ensure coverage and payment processing. Reviewed and determined contract and benefit eligibility with patients and providers. Researched and resolved all denial and appeal issues, reviewed clinical notes for accurately posted increment credits for psych visits and verified coverage, requested referrals and checked pre-certs for bariatric surgeries. Handled incoming calls, worked closely with providers and patients to ensure coverage and payment processing. Reviewed and determined contract and benefit eligibility with patients and providers. Researched and resolved all denial and appeal issues, reviewed clinical notes for accurately posted increment credits for psych visits and verified coverage, requested referrals and checked pre-certs for bariatric surgeries.



ACS Inc.

• Utilities
• 1 - 100 Employee

• Product Manager

  • Jan 2006 - Jan 2007

  Responsible for the daily operation of the SBU’s claim and Mailroom/Warehouse. Responsible for a large team of 110 nonexempt employees and 4 direct reports. Monitored staff to ensure timely and accurate processing of medical claims. Conducted prospective employee interviews, selected and supervised the training of new employees. Maintained a positive work environment and professional staff relationship. Ordered and authorized inventory, arrange for pickup and delivery of vender’s mail. Authorized shipping/receiving between SBU sites for operational purposes.



Wellpoint Anthem

• Insurance
• 700 & Above Employee

• CSR Billing Representative II

  • Jun 2003 - Oct 2005

  · Processed client and agent/broker inquiries pertaining to individual or group healthcare benefits. Analyzed and resolved billing issues, assisted policyholders by educating them on healthcare policy. · Processed client and agent/broker inquiries pertaining to individual or group healthcare benefits. Analyzed and resolved billing issues, assisted policyholders by educating them on healthcare policy.