T AM I KA L. WESLEY

**** ******* *****, ******, ** 75217

214-***-****

acevs9@r.postjobfree.com

Objective: To pursue my career in the healthcare insurance field. I have vast experience

performing tasks as a medical claims processor and coder, data entry clerk, proof-reader,

switchboard operator, mail distributer, customer service representative, inventory

shipper/receiver, and medical appeals analyst.

Work H istory:

Molina Healthcare of Texas-Inquiry D / A Resolution Coordinator (Oct. 2012-Feb. 2014)

Processed and completed Provider appeals for Medicaid, CHIP, Star, Star+

Researched and completed State complaints from H HSC for Medicaid, CHIP, Star,

S tar+

Performed and completed related special projects as assigned from supervisor

Aetna, Inc.-Claims Benefit Specialist (Nov. 2009-Oct. 2012)

Verified and corrected error messages on submit ted medical claims for Medicaid,

C HIP

Manually adjusted medical claims as needed

Performed and completed related special projects as assigned from supervisor

Dell /Perot Systems (temporary work)-Claims Analyst /Team Lead (Feb. 2008-Nov. 2009)

Managed Perot employees on project site of Aetna, Inc.

Verified and corrected error messages on submit ted medical claims for Medicaid,

C HIP

Manually adjusted medical claims as needed

Performed and completed related special projects as assigned from on-site supervisor

Tax Saver Plan-FSA Claims Administrator (Jan. 2006 – Feb. 2008)

Verified eligibility of submitted f lex spending account claims

Data entered and processed submit ted f lex spending account claims

Dell /Perot Systems (temporary work @ Great West Healthcare)-Customer Service

Representative (Aug. 2004 – Jan. 2006)

Responded to provider and member inqui ries via phone

Resolved eligibility, benefits, enrollment, and payment issues

Jacobson Group (temporary work @Cigna, Inc.)-Claims Analyst /Processor

Verified and updated ICD-9 & HCPCS codes on submit ted medical claims

Processed submitted medical claims for correct payment.

Blue Cross Blue Shield of Georgia (Mar. 2000-Nov. 2003)

Claims Associate I I I

Verified HCPCS codes on submitted medical claims

Data entered and processed submit ted medical claims for proper payment or denial

Customer Care Associate I I & I I I

Handled and resolved calls regarding benefit and claim issues

Handled supervisory calls regarding benefit and claim issues

Processed and adjusted submit ted medical claims

S kills:

M icrosoft Word, Excel, Outlook and PowerPoint, 10-key calculator, Typing, In ternet

E xplorer, Google Chrome, Windows 95, 98, XP and 7, NASCO, Adobe Acrobat Reader,

E ncoder Pro, Q-Care, Document Direct, Quicken Basics, XNet, Power M HS, I t rack, IView,

Customer Care System (CCS), Image Retrieval, Ben-Gui, Ben-Rumba, Linux, Telnet,

Q NXT, SharePoint, GEMS and similar billing software

Education:

Northwestern H igh School-Detroit, M I (Aug. 1986-June 1990)

General Studies

Randolph Vocational/Technical Center-Detroit, M I (Sept. 1988 - June 1989)

Word Processing

PSI Institute of Michigan-Southfield, M I (Jan. 1991 - Feb. 1992)

Word Processing/Data Ent ry

Sanford-Brown College-Dallas, TX (June 2014 - Present)

Medical Billing & Coding

R eferences Available Upon Request

Contact this candidate