Realtor

• Jun 2018 - Present

Medicare Risk Adjustment

• Jan 2015 - Present

I use data from 835s, 837s and X12 to make corrections to payments made to providers. It's a lot of math and balancing of reports.

Auditor

• Sep 2009 - Jan 2015

• Auditor for Critical Inquiries, Urgent Inquiries and Universal Screener Team (UST) using Access database as well Excel Spreadsheet– including Correspondence, Grievance and Appeals, and Enrollment cases.• Used CCP and GCP for the purpose of reading cases• Read and interpret claims in CAS • Trained three new associates on auditing UST as well as Urgent Inquiries.• Using my enrollment knowledge and background I helped Urgent Inquiries work cases in 2011 by going to MARx and researching members’ information to build cases for enrollment issues. • During 2009 Annual Enrollment Period part of a bailout team that helped Enrollment enter Authorization requests into CCP, reply to housing requests sent from various states, and using Marx and Litton, verified member’s demographics and made any corrections necessary in Customer Interface (C.I.) Show less

Grievance and Appeals Associate

• Apr 2008 - Aug 2009

• Researched and corrected member and provider issues navigating through Automated Enrollment, Customer Inquiry and CAS within the 30-60 day deadlines.• Requested Medical Records from providers to be used for further investigation by Humana’s Medical Director to ensure claims paid correctly. • Replied to email requests to research enrollment issues within Grievance and Appeal cases: Emails were sent back with all the proper attachments and documentation for the associate to properly close the case: Through my research I would create and send cases to CMS Processing Unit (CPU) to have the issues corrected and have the member’s enrollment updated correctly.• Entered Authorizations into CAS to allow claims to be paid properly by the Claims Associate. • 100% CMS Compliance Audits for November 2008 • 100% Grievance and Appeals Audits for November 2008 Show less

Billing and Enrollment Associate

• Sep 2006 - Apr 2008

My responsibilities included:• Built cases using MARx, Litton, and Customer Interface to be sent to Center for Medicare and Medicaid Services (CMS) for correction of member’s enrollment as part of the CMS Processing Unit (CPU)• Worked on Reply Codes and sent letters to members as part CPU team.• Successfully corrected pended issues in Automated Enrollment during the Annual Enrollment Period 2006• 100% Quality Audits for 2007 thru 2008

Middle School Math Teacher

• Aug 2005 - May 2006

My responsibilities included: • Daily Power Point presentations used to present lessons • Used CHAMPS Classroom Management to keep students focused and engaged on learning • Used hands on activity based learning to keep the students involved • Use of laptops and internet math sites to allow students to work at their own pace . My responsibilities included: • Daily Power Point presentations used to present lessons • Used CHAMPS Classroom Management to keep students focused and engaged on learning • Used hands on activity based learning to keep the students involved • Use of laptops and internet math sites to allow students to work at their own pace .

7th Grade Teacher- Hope Academy Broadway

• Aug 2004 - Jun 2005

My responsibilities included: • Daily Power Point presentations used to present lessons • Used CHAMPS Classroom Management to keep students focused and engaged on learning • Used hands on activity based learning to keep the students involved My responsibilities included: • Daily Power Point presentations used to present lessons • Used CHAMPS Classroom Management to keep students focused and engaged on learning • Used hands on activity based learning to keep the students involved

Manager

• Feb 1996 - Jul 2004

• Supervise crew members to be sure they stayed on task and ensure orders completed correctly and in a timely manner • In charge of making sure safe was accurate and cash deposits done correctly • Made sure store opening and closing procedures were followed on a daily basis • During down time made sure crew completed daily cleaning list and worked on any special cleaning projects that needed to be completed. • Supervise crew members to be sure they stayed on task and ensure orders completed correctly and in a timely manner • In charge of making sure safe was accurate and cash deposits done correctly • Made sure store opening and closing procedures were followed on a daily basis • During down time made sure crew completed daily cleaning list and worked on any special cleaning projects that needed to be completed.