Deveneir Street
LAGRANGE
Summary
Claims Representative with a strong commitment to delivering exceptional customer service and resolving claims efficiently. Possesses advanced communication skills and a readiness to learn and adapt quickly in dynamic environments. Demonstrates timeliness and people skills, ensuring a seamless claims process for clients.
Overview
6
6
years of professional experience
Work History
PROVIDER ENROLLMENT SPECIALIST
Amerihealth
Remote
03.2023 - Current
- Performs follow-up with market locations to research and resolve payer enrollment issues
- Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payer via phone, email or website to resolve any Payer Enrollment issues
- Manages the completion and submission of CMS Medicare, State Medicaid and any other third-party payer applications
- Performs tracking and follow-up to ensure provider numbers are established and linked to the appropriate client group entity and proper software systems
- Maintains documentation and reporting regarding payer enrollments in process.
- Retains records related to completed CMS applications
- Establishes close working relationships with Clients, Operations, and Revenue Cycle Management team
- Proactively obtains, tracks, and manages all payer revalidation dates for all assigned groups/providers as well as complete, submit, and track the required applications to maintain active enrollment and prevent deactivation
- Maintains provider demographics in all applicable enrollment systems
- Adds providers to all applicable systems and maintains information to ensure claims are held/released based on status of enrollment
CLAIMS REPRESENTATIVE
Anthem
Midland
08.2019 - 02.2023
- Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
- Researches and analyzes claims issues.
- Processed medical, vision and dental claims efficiently, ensuring accuracy and compliance, which led to a reduction in payment errors and enhanced client satisfaction.
- Approves, denies, and appeal claims from queue system called availity
- Compare insurance information that's available in Epic. Update in both Epic and Availity
- Investigated complex claims issues, employing critical thinking to identify root causes and implement solutions that improved processing times.
- Maintained comprehensive records of claims adjustments, ensuring data integrity and adherence to company policies, resulting in improved audit outcomes.
Education
HIGH SCHOOL DIPLOMA -
Kendrick High School
Columbus, Ga05.2010
Skills
- Exceptional customer service
- Claims processing
- Advanced communication
- Critical thinking
- Data integrity
- Payer enrollment management
Timeline
PROVIDER ENROLLMENT SPECIALIST
Amerihealth
03.2023 - Current
CLAIMS REPRESENTATIVE
Anthem
08.2019 - 02.2023
HIGH SCHOOL DIPLOMA -
Kendrick High School