Experience

Care N' Care Insurance Company

• United States
• Insurance
• 1 - 100 Employee

• Provider Concierge

  • May 2019 - Present

  • Works to maintain provider relationships via provider contact• Provides education to contracted providers through direct contact and provider orientations• Serve as liaison between payers and providers in operational areas• Make regular “good will” visits to providers and act as primary resource for problem solving• Assist with training and development programs• Collaborate with provider and their staff to ensure practice goals are aligned with RAF and Quality • Ability to resolve provider issues regarding compensation ,claims ,care management quality , and other matters• Ability to identify trends and escalate issues were the root cause is not isolated to one error• Conduct on-sight education , webinars, support and training for physicians and staff to include initial physicians orientation as well as new initiatives , programs, policies and procedures• Retrieve ,distribute provider reports monthly • Proactively conduct outbound follow-up and resolution calls in a timely and professional manner.• Assist provider offices with setting up log-in information to access the provider portal for claims and eligibility & benefits, authorization and or referral • Consistently strives to establish provider satisfaction by providing excellent customer service.• Review claims for appropriate adjudication; triage and track claims for reprocessing with claims vendor.• Documents phone call information clearly, accurately and timely into tracking system.• Send needed documentation, like provider remittance advice to provider offices upon request.

• Provider Claims

  • Dec 2016 - May 2019

  • Answer the phone and speak with doctors / and medical billers• Respond in a timely manner to providers about their inquires about claims• Worked spreadsheets on outstanding payments and denials • Supervised and maintained the department voicemail’s and email’s• Coordinate with provider’s about benefits and copays• Work remotely from home• Inbound/outbound calls • Ensured compliance with Medicare, Medicaid ,managed care rules and regulations • addressed denial reason’s on claims • Set goals• Training coworkers to understand claims• Locating Claim issues and Trends• Provide guidance to provider pertaining provider resources and tools• Review and generate dispute letter’s for in network provider’s



Visiting Angels

• Health, Wellness and Fitness
• 100 - 200 Employee

• Caregiver

  • Mar 2016 - Dec 2016

  • Personal caregiver for the elderly-patients that have Alzheimer’s , dementia , and or Parkinson’s Disease.• Caregiver for patients with disabilities • Being a support system to the elderly



Wetseal Inc

• United States
• Retail
• 1 - 100 Employee

• Sales Associate

  • Oct 2014 - Dec 2016

  · Cashier · Sales Associate· key holder · Cashier Trainer



Centene Corporation

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

• Advanced Claims Analyst

  • Feb 2015 - 2016

  • Advanced Claims Analyst / Team Lead/ Point Of Contact • Adjusting Medical claims• Coordinate insurance • Reviewing Medical Records• Running reports for daily work• Appeal/Correspondence• Special Projects –Any group of 10 or more claims requiring adjustment as a result of a State Compliant, Depart of Insurance directive, compliance issue, and/or legal proceeding.• Working Crm’s (Customer Relationship Management) – provider customer service rep and provider with information on why a claim is denying and or is not properly paying . / Running Crm Reports • Mentor/ Point Of Contact - a person to whom answers everyone questions and Up Train someone if needed.• Looking over medical records determining rather to deny or pay medical claims.• Sending letters to providers• Working claims Payable –claims that stuck in the system and has not hit a pay status because of a configuration issue.• High Dollar claims • Data entry• Following CMS guideline’s• Reviewing HCFA claim form’s, and or UB ‘s • Reviewing Contract’s and Agreement’s



HealthFirst TPA

• United States
• Insurance
• 1 - 100 Employee

• Claims Examiner

  • Mar 2014 - Feb 2015

  · Matching providers in the m837· Logging appeals and pred’s· Reading faxes· Paying prescriptions· Paying and Processing claims· Working Dental Claims · Filing Electronic Medical Records· Medical Claims· Data entry



Walmart

• United States
• Retail
• 700 & Above Employee

• Cashier

  • Sep 2012 - Feb 2014

  · Cashier /Trainer· Sales Associate· Customer service/answering phones