Raymond Hoursey

*** * ****** **. *** * Elizabeth, NJ 07206 Cell: 347-***-**** Email: acf89i@r.postjobfree.com

Professional Experience:

Express Scripts Franklin Lakes, NJ 4/13-

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Associate Business Analyst

• Manage Formulary Rebate and Guarantee True up payments for assigned clients, ensuring accurate and timely payments

• Perform monthly review of new contract terms and maintain central database with accurate and up-to-date terms as well as

updating our Essbase accrual model in order to assist with the monthly close process.

• Perform account reconciliations at the client level on a monthly basis for certain formulary accounts.

• Prepare manual rebate payments and annual guarantees as required from the company.

• Provide support to account teams regarding formulary rebate and Ingredient Cost discount information as required.

• Tier testing analyst, running grids to get correct cost information for each client using Excel in all aspects of the program.

Horizon Blue Cross Blue Shield Newark, NJ 9/11-10/12

Benefits/Claims Medical Billing Specialist

• Accurate set up of benefits and eligibility for Managed Care products.

• All claims corrections and reprocessing claims adjustments, approx. 130 claims per day adjudicated.

• Verified benefits; obtained precertification / authorizations / deposits / co pays/ deductibles as required.

• HMO/Managed Care claims adjudication for medical provider offices, hospitals, and other facilities.

• Research claim discrepancies and log results and issues. ICD9 and ICD10 coding.

RealSoft Inc. /ACS Little Falls, NJ 8/10-4/11

Benefits Specialist

• All aspects of customer service, responsible for call volume and quality of calls.

• Responsible for answering billing questions on healthcare benefit premiums, prescription drug costs, and open enrollment.

• Administering healthcare benefits and answering healthcare claim questions and all benefits enrollment for participant of

Procter and Gamble, IT (Help Desk) for healthcare website.

• Procter & Gamble claims review for billing errors and log results.

• Accurate set up of benefits and eligibility for health, life and prescription plans.

MedAssetts Inc. Mahwah, NJ 6/09-6/10

Customer Service Medical Billing Specialist

• Responsible for answering patient billing questions, Self Pay and Health insurance billing.

• Obtained and posted payments from patients for various hospital facilities.

• Used various programs such as Summit, Marrs, Affinity, use of health insurance website data collection for billing purposes.

• Mailed individual bills to patients for self pay accounts and health insurance by printing UB04 from Doctor. Script for both

outpatient and inpatient hospital claims with diagnosis coding included.

• Analyze adjudicated claims to insure accuracy, send corrected claims back to insurance companies for re-adjudication of

corrected information.

Horizon BCBS of NJ Newark, NJ 07/05-03/09

Customer Service Claims Specialist

• Responsible for accuracy and quality of calls on a daily basis.

• Accurately quoted health insurance benefits on a daily basis and following up on a weekly basis in Excel.

• Advised and processed incoming callers including hospitals on insurance claims, status, and payments.

• Verified benefits; obtained precerts / authorizations / deposits / co pays as required, and claims adjustments.

• Research claim discrepancies and log results, issues. All claims adjudication and corrections, ICD9 and ICD10 coding as well.

BN.Com Secaucus, NJ 10/04-07/05

Member Services Representative

• Handled customer inquiries which included following up with delivery times of items purchased.

• Responsible for accuracy and quality of calls from customers and Data Entry.

• Verified and processed customer orders on a daily basis as they were called in.

Professional Skills:

• Word for Windows, Word Perfect, Excel, Webmaster, Microsoft Outlook, Lotus, Cars IOS, CAD IOS, Windows applications.

• Internet applications. Nasco,Q-Blue, Windows claim applications, tpx systems, Aware caller systems,

• Cisco Medical Applications,UCSW,Summit,Envision,Navinet,All insurance applications, Emdeon, Speedy Claims,

• Heartlink and Affinity Systems. IT Technical support, website help desk.

References Furnished upon request

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