Experience

NTCA–The Rural Broadband Association

• United States
• Telecommunications
• 100 - 200 Employee

• Claims Specialist

  • Aug 2015 - Present

   Promotes positive relations with NTCA Member Companies, UHC, and providers by delivering timely, professional, and accurate processing of hospital, medical, and dental claims.  Effectively deals with workload while remaining persistent and optimistic under difficult situations.  Processes all claims in accordance with NTCA specifications proficiently using applicable Desk Procedures and Claims Processes while exceeding daily and monthly productions standards and quality audits.  Coordinates with UHC, BRU, and other departments and vendors as necessary to ensure appropriate payment of benefits is maintained by verifying accuracy of billings and statements and requesting and receiving of medical records when required.  Identifies and reports potential trends that may have impacts on quality and production. Makes recommendations on system improvements.  Processes adjustments, quick entry, quick claim, Medicaid claims, and other Administrative Tasks as required.  Maintains PHI and confidentially handles medical data and records in the appropriate manner according to NTCA guidelines.  Ability to effectively assist with other special projects and duties such as processing returns/refunds, processing 2016 mid-year UCR adjustments, and the 1095 Project. Show less



Appalachian Regional Healthcare System

• United States
• Hospitals and Health Care
• 500 - 600 Employee

• Billing and Follow Up Specialist

  • Jan 2013 - May 2014

   Directly worked with management and personnel throughout multiple departments to achieve overall goals of the organization by identifying ways to create efficiencies, improve processes, and increase accuracy.  Monitored daily billing reports for denials and rejections, claim holds, and correction of errors that prevent electronic billing. Identified carrier trends and made recommendations to management.  Understands the requirements of governmental and commercial programs to ensure that the necessary documentation is obtained for billing the appropriate party to increase revenue and maintain compliant billing processes.  Coordinated requests between various departments to ensure necessary requested information such as medical records, referrals, and authorizations were obtained and delivered to the appropriate party. Show less



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Senior Customer Service Representative

  • Jan 2003 - Aug 2012

   Directly contributed to company performance by offering expertise, reliability and continuity in benefits and claims procedures and established clear lines of communication between clients and company.  Utilized comprehensive knowledge of benefit and claims analysis to provide effective response to customer queries, including escalated supervisor issues, with emphasis on high levels of customer service over different contact channels including telephonic support.  Responsible for scrutiny and analysis of claims returned from the claims processing department with focus on reduction in overall percentage of adjustments for the Provider Service Center for the years 2005 - 2012 as assistant day to day project lead.  Monitored day to day workflow, deadlines, and performance of associates also working on special projects.  Coached and mentored employees in their overall development while providing constructive feedback. Feedback was given monthly and annually to individual employees’ and their immediate supervisor. Overall team and division feedback was also provided to upper management.  Closely collaborated with cross functional teams across departments such as claims, appeals and provider contracting for streamlining of workflow and policy.  Directly worked with Network Account Managers to resolve complex issues to ensure overall provider satisfaction and maintain provider participation in network of physicians.  Involved with identification of training needs and developed the framework of training programs to build capability within the team and enable new hires to become effective contributors to team efforts.  Performed administrative duties including but not limited to the filing and maintenance of up-to-date, accurate and confidential client files and document preparation.  Developed, analyzed and presented reports to provide information updates on operational performance, prevailing trends and problems to top management. Show less