Dorline Marie Taylor

* * * * * M I N G T O N A V E N U E • G A L L A T I N, T N 3 7 0 6 6

P H O N E 6 1 5 – 7 1 5 – 1 0 9 2 • E - M A I L ad4pyp@r.postjobfree.com

PROFILE SUMMARY

** ***** ** *****ience in managed care, detail-oriented, and conscientious self-starter, able to strategize and prioritize effectively to accomplish multiple tasks while supporting team members with projects and organizational goals.

PROFESSIONAL EXPERIENCE

Amerigroup

Credentialing Specialist Senior 2016 – Present

Conducts formal review of Contracts and Credentialing documents.

Builds file documentation and prepare for credentialing committee review.

Applies general guidelines in determining whether provider meets criteria and documents deficiencies.

Prepares correspondence to providers regarding status.

Assists in researching pended and probated applications and resolving discrepancies.

Develops provider education and training materials.

Claims Resolution Analyst Senior 2014 – 2016

Investigates and facilitates the resolution of claims issues.

Assists in the reviews of state or federal complaints related to claims.

Responsible for coordinating the resolution of claims issues by actively researching, analyzing systems, and processes that span across multiple operational areas.

Work with programming staff to ensure requirements will be incorporated into system design and testing.

Acts as liaison with users of the software to address questions/issues.

Claims Resolution Analyst 2010 – 2014

Investigates and facilitates the resolution of claims.

Interact with providers and health plan on issue resolution.

Performs user acceptance testing to ensure new contracts are loaded correctly.

Healthspring

Senior Claims Processor 2006 – 2010

Used analytical skills to identify issues and proactively engage to solve problems that may negatively impact customers.

Processed medical, durable medical equipment, ambulance, home infusion, and vision claims.

Coordinated benefits with primary insurance payments.

Skills

Microsoft Word, Excel and Outlook

Analytical Skills

Customer Service

Facets

CAQH

Problem Solving Skills

Leadership Skills

Macess

Cactus

EDUCATION

Glencliff Comprehensive High School Nashville, Tennessee

High School Diploma (1983)

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