Professional Experience
8/2008-4/2013 First Coast Service Options Jacksonville, FL
Medicare Provider Enrollment Analyst
Screen, validate and process sensitive information given by providers. Verify the information related to the provider enrollment application using the CMS systems (PECOS, MCS, NPPES, Excluded Parties List, and Medicare Exclusions Data Base) Internet and other databases deemed appropriate. Research and develop for additional information as needed to complete the enrollment application. Act as customer service liaison to ensure that complex issues are resolved timely. Interact daily verbally or in writing with physicians, attorneys and billing agents.
11/2006-8/2008 First Coast Service Options Jacksonville, FL
Reconsideration Analyst
Input appropriate data regarding reconsideration cases into the Medicare Appeals System. Build reconsideration case files from evidence submitted and received and analyze each case to ensure it meets the requirements for a valid reconsideration request as mandated by CMS. Develop reconsideration cases for Medicare beneficiaries in accordance with statutes, regulations, rulings and CMS guidelines. Support Reconsideration Professionals and Associate Medical Directors in the development, research, and closure of reconsideration cases. Support Administrative Law Judges by forwarding reconsideration cases to them upon request and creating decision files when decisions are received.
8/2005-11/2006 First Coast Service Options Jacksonville, FL
Service Associate
Examine, interpret and enter Medicare claims data accurately into the claims processing system in a timely manner according to CMS guidelines. Effectively make decisions to properly handle claims and inquiries. Make adjustments or cancellations on claim submissions from providers. Build strong relationships with internal and external resources.
2/2004-8/2005 Blue Cross Blue Shield of Florida Jacksonville, FL
Customer Advocate
Receive and handle calls in a contact center environment from customers, physicians and other providers. Works within Health Business Service Organization to research, resolve and respond to written, electronic and telephone inquiries. Examine, interpret and enter claims data into Diamond the claims processing system in a timely manner. Educate and inform customers regarding the use of products, programs, features and benefits based on customer’s needs,...
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