Humana Specialty Pharmacy April 2017 – Present
Finance Claims Auditor
• Perform audits and monitor high dollar specialty pharmaceutical claims and AR records
• Coordinate with Assistance programs and departments to resolve payment and outstanding claim issues
• Audited and Resolved old AR records in a year or less timeframe
Anthem Feb 2016 – Mar 2017
Grievance & Appeals Representative
• Investigated and resolved grievances & appeals within plan, regulatory and accreditation timeframes
• Maintained and adhered to follow-up activities and final outcomes in Facets & PEGA systems
• Tracked first and second level appeal request
Mercy Health Nov 2014- Dec 2015
Revenue Cycle Claims
• Analyzed denial reasons and prospectively plans follow-up steps utilizing the Epic billing system.
• Maximized rebilling and reprinting of claims as well as Assisted with billing & coding. Resolved coding issues & edits
• Examined and handled Workers Compensation Claims & Billing
The Christ Hospital April 2013-Nov 2014
• Scheduled appointments for surgery, office visits, testing, and procedures
• Screened patient information during admission and registration during the check-in/out process
• Collaborated Cardiologist Schedules
Humana Health Insurance July 2008 – April 2013
• Applied critical thinking skills to resolve complex customer and provider inquiries about health insurance benefits, claim processing, and payments
• Trained and developed 10-12 associates
• Identified customers’ needs, clarified informa...
Login or Register to view the full resume.