Customer Service High School
Resume:
Michelle Young Objective
**** ** **** ** ** obtain a challenging and fulfilling position, where I
East can use my knowledge and experience for opportunity and
Apt 302 growth.
Humble, TX 77346
michelleyiii@yahoo
.com
Employment History
Network Coordinator
August 2009 to April 2010 Independence Blue Cross,
Philadelphia, PA
Serviced a defined segment of high profile professional,
hospital and ancillary providers by educating them
regarding new initiative and changes in medical and claims
payment policy and related operational procedures. Worked
collaboratively with Contracting and Reimbursement to
support decisions and negotiations during the
re-contracting process.
Conducted root cause analysis and worked collaboratively
with staff in other business areas to assist with the
resolution of complex provider issues and achieve expected
goals/outcomes within established timeframes.
Independently researched and analyzed the issues that
impact these providers, including but not limited to issues
regarding claim payments, provider data file discrepancies.
Quality Incentive Payments (QIPS), capitation, medical
policy, utilization management, and other compliance
initiatives.
Business Specialist
December 2006 to August 2008 Independence Blue Cross,
Philadelphia, PA
Responsible for accurate and timely responses of executive
inquiries, claim issues received from hospitals,
physicians, members, other insurance companies, as well as
State and Federal Department of Insurance.
Supported the claim processing, adjustment and Plan 2 Plan
departments by conducting chair side training and
forwarding valuable information to the associates as
needed.
Representative for the implementation of various projects
corporate and departmental such as Blue Cross Blue Sheild
Association BlueSquared System for Out of Area Claims, HCAT
Representative for internal system to make changes to the
processing of claims as needed and priced special Mental
and Substance Abuse Claims.
Provider Claim Service Specialist
February 2004 to December 2006 Independence Blue Cross,
Philadelphia, PA
Resposible for applying checks and adjusting claims in the
IBC internal system that are received from Hospitals,
Physician's and subscribers for the correct claim and
account in a timely and accurate fashion.
Independently adjusted the claims and processed them
correctly in the internal adjustment system to ensure the
member's benefit as well as the group are receiving the
correct monies due to refund received.
Check request would be initiated if the findings of the
check deemed to be inaccurate for various reasons such as
overpayment received, monies already applied, system
updated and corrected payment, etc.
Claims Payment Adjuster
December 2001 to February 2004 Independence Blue Cross,
Philadelphia, PA
Research provider and subscriber information using various
internal systems
Responsible for accurate and timely processing of facility
claims payment adjustment request received from various
internal and external sources
Completion of various project
Education
1992 to 1995 Willingboro High School, Willingboro, NJ
High School Diploma
Other Experience
Completed Time Management Training Course
Experience using Microsoft Office (outlook, excel, word)
Some experience using Microsoft Office (Access, Powerpoint
and One Note)
Administrative Assistance Skills (filing, typing,
scheduling, customer service/greeter, etc)
References
References are available on request.
Contact this candidate