Experience

Anthem

• United States
• Insurance
• 700 & Above Employee

• Operations Expert,CSBD PI Cost Avoidance

  • Feb 2019 - Present

  Responsible for providing technical direction, guidance, and resources to associates on a day-to-day basis. Primary duties include, but are not limited to: Handling complex case research and resolution. Monitoring inventory to ensure workflow remains uninterrupted. Review, interpret and maintain records of service level, quality, accuracy, and productivity. Reviewing department policy and procedure manuals for accuracy. Serves as a first-line resource for operation associates for workflow and technical related processes. Provides operational training as well as working with the training department to ensure procedures and policies are accurate and complete. Encourages a teamwork environment.

• ECOB Specialist

  • Mar 2004 - Jan 2019

  Research and investigate other coverage for all of the company's groups and members. • Perform multi-complex functions and interpret complex rules, laws and contracts. • Accountable for end-to-end functionality on every COB function including reconciliation of claim, membership and accounting. • Utilize internal queries, internal resource tools, initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report to identify members who are or should be enrolled in other coverage. • Aid members in enrolling in Medicare when they are entitled. • Update all of the company's membership system components with investigation results for claim coordination. • Ensure correct forms are provided to assist members enrolling in Medicare. • Review claim history to reconcile processed, pending or recovered claims for any errors. • Identify the correct formulas in order to adjudicate impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.



Medical Device and Health Industry

• Medical Equipment Manufacturing
• 1 - 100 Employee

• Project Coordinator

  • Jan 1999 - Oct 2002

  Assisted in the streamlining of the Provider Contract Research Database (I.e. creating, researching and maintaining provider contract records.) Researched and created reports in regard to hospital claim issues using CPT codes in Rims, Iliad and Excel. Created and followed through with research and adjustment of provider claims. Created and maintained provider tracking reports for use in analysis of provider movement and availability for members of PacifiCare Health Insurance. Supported rural and southern offices in regard to projects and administration. Assisted in several major re-contracting projects. Created and maintained accurate files on new and existing providers. Updated database using Provider Information Forms in Access. Provided customer support for providers and their offices. Mailed, faxed, and created provider correspondence. Created analysis for provider fee schedules from McGraw Hill to RBRVS.