Claim you profile
Bronx, New York, NY, USA
Home Health Residential Aide
June 2013 - May 2014
Successfully provided daily care for resident in a home health setting
• Assisted resident in daily activities to provide maximum care
• Assisted resident in scheduling appointments, obtaining referrals, and escorting resident to and from daily activities
Insurance Specialist/Coder II
October 2008 - May 2013
• Successfully assisted providers and/or patients in verifying eligibility of benefits for submission of claims
• Successfully educated providers on authorization processes to receive maximum claim reimbursement
• Verified Insurance coverage via telephone, online, and through the Electronic Verification System(EVS)
• Analyzed and processed appeals for Medicare Part D Prescription Drug Plan
• Supported doctors, hospitals, and Health Plan in obtaining prior-authorization for pre-services and post services for Medical and Pharmacy services
Appeals and Grievance Analyst
July 2004 - October 2008
• Processed appeals for Quality Improvement Organization, Centers for Medicare and Medicaid services
• Performed necessary claim adjustments as required per the appeal resolution. This includes advanced levels of claims transactions/claim types and coordination of benefits.
• Analyzed system authorization to ensure accurate data entry with an understanding of Medical Management department's administrative processes and guidelines.
Schaller Anderson of Maryland
February 2002 - July 2004
• Process Incoming grievances and appeals for (Member, Provider, Hospitals)
• Process Claim Payment requests and generate request for Explanation of Payment/Benefits due to coding discrepancies and/or improper usage of codes.
• Provide customer support via inbound and outbound telephone calling to answer question from (Members, Provider, or Vendors)
• Prepare weekly reports for the Medical Management team
Switchboard Operator, Administrative Assistant, and Appeals Coordinator
April 2001 - January 2002
Unit Clerk Health Assistant, Cashier, Switchboard Operator
Humana Group Health Plan
March 1989 - April 2001
Qualifications & Certifications
Academy of Professional Coders
CGNA Petersburg School of Practical Nursing
Is this your profile?
If this is your profile, then you can claim it now and log into your account.