Experience

Lumeris

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

• Senior Enrollment Specialist

  • Sep 2022 - Present



Lumeris/Essence Healthcare

• Enrollment Specialist

  • Mar 2015 - Present

  *Review and analyze Coordination of Benefits to ensure accurate payment on members’ claims by abiding by government guidelines *Assist with training of new hires to adhere to company policies and procedures *Review CMS (Centers for Medicare & Medicaid Services) systems for accuracy of member information for application processing *Send transactions to CMS to update member records accurately *Reconcile daily/monthly reports *Ensure eligibility transactions successfully interface with downstream systems based on an understanding of each system’s processing rules and interface limitations *Research eligibility discrepancies *Perform audits for compliance Show less



One Transportation LLC

• Human Resource Coordinator

  • Sep 2016 - Jun 2020

  *Performed phone and face-to-face interviews with prospective candidates *Scheduled trainings and pre-employment screenings; such as drug and background screenings *Assisted with calculating employees’ working hours *Attended business/career fairs to bring in prospective employees *Assisted with writing up contractual agreements *Utilized career sites such as Indeed to analyze and search for possible candidates for hire *Performed phone and face-to-face interviews with prospective candidates *Scheduled trainings and pre-employment screenings; such as drug and background screenings *Assisted with calculating employees’ working hours *Attended business/career fairs to bring in prospective employees *Assisted with writing up contractual agreements *Utilized career sites such as Indeed to analyze and search for possible candidates for hire



The Outsource Group, a Parallon company

• Insurance Claims Specialist

  • Jun 2013 - Feb 2015

  *Verify patients’ insurance eligibility in order to bill medical claims*Bill an average of $1Millon for medical claims per month*Train and audit individual’s work to ensure accuracy for billing medical claims*Research and analyze medical claims (utilizing Navinet, Availity, Passport AS400, SMS3270, Star, AIX 6; hospital software) to verify accuracy; including making sure all adjustments and insurance payments are applied correctly*Follow up on an average of $100,000 of insurance payments per month to assist in increasing revenue for our clients/hospitals *Verify patient’s eligibility for Medicare Part A or B benefits by determining what services were rendered and if a patient’s deductible is met*Researching and determining if a patient opted in a Medicare replacement plan in order for the medical claim to be billed correctly; Research and determining a patient’s COB (Coordination of Benefits) in order to bill the claims correctly Show less

• Patient Access Specialist

  • Dec 2012 - Jun 2013

  *Worked with healthcare insurance companies, hospital clients, and patients by researching account issues and completing necessary correspondence to facilitate account resolution*Provided financial gain for our healthcare clients by ensuring queue/collections goals were met*100% compliant in following all FDCPA regulations and system procedures



Cardinal Health

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

• Coordinator, Field Services

  • Nov 2003 - Mar 2012

  *Assisted pharmacies with Managed Healthcare, pharmacy benefits and insurance inquiries *Responded to an average of 100 of incoming and outgoing customer calls daily *Managed and obtain relationships with retail pharmacies and their franchisees as well as the District Personnel with the products and services we provided *Collaborated/Interacted with other departments, employees, and franchisees to develop knowledge about their goals, standards, policies and procedures for best results *Distributed and promoted communication items, as well as personally communicate with franchisees to inform them of adequate information such as; new or modified Medicare regulations needed to operate their independent retail pharmacies *Assisted with information technology in regards to new software, log-in information, navigation through intranet, and accessibility to websites for franchise customers as well as District Personnel *Provided information to potential franchisees’ on the process of obtaining new products and services to incorporate in starting-up their independent pharmacies *Averaged 10 new franchise opportunities inquiries daily *Managed record keeping and data for Franchise Business Consultants’ store visits for the Medicine Shoppe/Medicap retail pharmacies *Placed, prepared, researched deliveries regarding product orders *Facilitated and trained new hires in financial services, such as; billing store products and ensuring that the billing statements are accurate (abiding by the policies and procedures) for the Medicine Shoppe/Medicap pharmacies *Trained new hires in customer call handling and in company’s policies and procedures *Placed an average of 30 franchise product orders daily *Tracked and documented daily call volume, call substance, and call resolution through the HEAT System Show less



Managed Pharmacy Benefits (Formerly a Cardinal Health Company)

• PBM Representative

  • Nov 2002 - Oct 2003

  *Assisted retail pharmacies’ staff with processing and adjudicating (utilizing 835/837 software) claims by abiding by the appropriate insurances’ policies and procedures *Provided support to patients by answering their questions regarding their pharmacy insurance benefits *Assisted retail pharmacies’ staff with processing and adjudicating (utilizing 835/837 software) claims by abiding by the appropriate insurances’ policies and procedures *Provided support to patients by answering their questions regarding their pharmacy insurance benefits