Experience

Royal Health Care

• Hospitals and Health Care
• 100 - 200 Employee

• Financial Analyst

  • Apr 2016 - Present



St James

• Administrative Assistant

  • Aug 2015 - Nov 2015



Royal Health Care

• Hospitals and Health Care
• 100 - 200 Employee

• Eligibility Specialist

  • Dec 2014 - Aug 2015

  .Responsible for bimonthly roster reconciliation for each Medicaid product;distributing ; preform various processes on reports("work" the reports) as required.. Responsible for the resolution of MHS and MCTM enrolment errors ,panel transfers, eligibility file errors and reconciliation.. Dummy CIN assignment process for all Lines of Business.. Submission of Facilitated Enrollment files and Medicaid Enrollment files to Maximus.. Oversee the resolution of claim / member issues to enable processing of claims.. Act as a resource to various departments on membership issues and error resolution. Show less

• Analyst

  • Oct 2011 - Dec 2014

  . Review providers contracts.. Set up reimbursements according provider agreements.. Update Medicaid Fee Schedules.•Examine, data enter, calculate and adjudicate insurance claims in compliance with federal, state, and county laws, plan policy and •Company policies and procedures.•Maintain individual production count.•Adjust finalized claims for correct reimbursement, claim corrections and errors.•Analyze system to identify problems / issues as they pertain to claims processing and elevate those issues to management•Identify issues based on provider inquiries and elevate those issues to management.•Make recommendations to drive change in an effort to improve departmental service levels.•Complete projects as assigned.•Retrieve and respond to voice mail messages left from providers. Show less

• Claim Correspondence Analyst

  • Jul 2009 - Nov 2011

  •Review, research and respond to daily correspondence received from .•Provide world class service to our providers and plan representatives by efficiently responding to written inquiries from providers and the plan.•Examine, data enter, calculate and adjudicate insurance claims in compliance with federal, state, and county laws, plan policy and •Company policies and procedures.•Maintain individual production count.•Adjust finalized claims for correct reimbursement, claim corrections and errors.•Analyze system to identify problems / issues as they pertain to claims processing and elevate those issues to management•Identify issues based on provider inquiries and elevate those issues to management.•Make recommendations to drive change in an effort to improve departmental service levels.•Complete projects as assigned.•Retrieve and respond to voice mail messages left from providers.•Assist Provider Service Advocate’s by handling incoming provider telephone inquiries upon request. Complete miscellaneous assignments upon request Show less



Tesia Clearinghouse, LLC

• United States
• IT Services and IT Consulting
• 1 - 100 Employee

• Customer Service / Operations Support /Specialist

  • Jul 2007 - Jul 2009

  •Processing Eligibility files from the insurance companies and putting them into production at the end of each business day. •Checking the systems every half hour to make sure there are no complications, such as, claim sessions locking up, checking our systems to ensure that our connections to the insurance companies are operating normally. •Rebooting multiple servers on a daily basis. •Processing Dental Claims from various insurance companies, through our proprietary programs. •Transmitting and receiving the claim files or reports from the insurance companies via their Web Sites, Ftp Server or Cuteftp or Secure Fx. •Effectively track activities using company Customer Relationship •Management (CRM) system. •Actively learn company tools for researching customer claims and technical issues. •Provide support to Operations and IT /IS departments. •Suggested new products that increased earnings by 23%. •Customer Service Specialist •Assisting the Dental office with their claims. •Researching any claim issues. •Retrieving reports for the offices and placing them back into files in our systems so they can be downloaded. •Providing resolutions on why claims failed or were rejected. •Faxing over the necessary documents so that the providers can register to send their claims through our company. •Calling our clients and walking them through the steps on how to upgrade our various programs. •Explaining to providers how our solutions work with their Practice •Management Software. •Performing duties to support Payer and Partner services. Show less



Empire Medicare Services

• Claims Examiner

  • Jan 2006 - Jul 2007

  •Simultaneous evaluation and data entry into systems for Medicare Part B claim dates, as well as edit resolutions of claims in accordance with the guidelines that are set forth by Medicare and the Centers for Medicare and Medicaid Services.•Evaluation and resolution of suspended claims by researching, accessing, and applying various database files and instruction.Retrieval of correct information and successfully processing claims on timely basis. •Consistently exceeding minimum requirement of 50 claims per hour. Show less

• Customer Service Specialist

  • Oct 2005 - Jul 2007

  •Servicing both internal and external customers on the Beneficiary line of the call center, customers include Medicare beneficiaries.•Social Security Administration and advocacy groups, independent research, investigation and resolution of basic telephone inquiries and complaints. •Providing accurate and complete responses to the beneficiary inquiries concerning enrollment, billing, eligibility, contract benefits and claim issues. •Resolving inquiries using corporate information systems including MCS, MCSDT, NGD, HIMR, Federal Internet sites, Medicare Policy Manuals, the Customer Service Manual and related intranet resources.•Successful resolution to inquiries from irate or dissatisfied callers.Assessing the necessity of and initiating proper action towards filing a re-determination.•Identifying and referring inquiry trends and potential system errors or problems related to calls. •Participating in unit meetings and training to help identify frequently asked questions and issues form the beneficiaries.•Performing all duties assigned by the Supervisors. Show less



Millennium Medical Pc

• Billing Referral Clerk

  • Jan 2004 - Oct 2005

  •Posting payments for insurance companies to patient accounts. •Billing patients for tests or procedures that were not covered. •Calling insurance companies for authorization on various tests and durable medical equipment. •Scheduling appointments for patients. •Calling insurance companies to check patients’ eligibility. Filing patient documents into their computer based files. •Responsible for tracking and sending the claims to the insurance companies. •Posting payments for insurance companies to patient accounts. •Billing patients for tests or procedures that were not covered. •Calling insurance companies for authorization on various tests and durable medical equipment. •Scheduling appointments for patients. •Calling insurance companies to check patients’ eligibility. Filing patient documents into their computer based files. •Responsible for tracking and sending the claims to the insurance companies.