Customer Service Years Experience
Resume:
KEVIN V EMERY
Email: ********@*****************.***
Address:
City: Philadelphia
State: PA
Zip: 19146
Country: USA
Phone: 215-***-****
Skill Level: Any
Salary Range:
Primary Skills/Experience:
10 years claims experience in a healthcare environment.
10 years experience in a customer service & customer support role.
Several years experience as an Enrollment/Benefits Specialist
Educational Background:
High School Dipolma from Community College of Philadelphia, Phila PA 1/2001 to 5/1987 (Business Admin)
Job History / Details:
Career Overview
10 years experience in a customer service & customer support role.
10 years claims experience in a healthcare environment.
Several years experience as an Enrollment/Benefits Specialist
Core Strengths
Extensive knowledge and training in 5010/837 EDI submission & support.
Proficient in Window and Microsoft Office products.
Strong organizational skills.
Possess excellent written,
communication,and analytical
skills.
Work Experience
7/01/2003 to 6/13/12
Community Behavioral Health Philadelphia
Claims Analyst
Analyze the billing trends of in network, and out of network provider claims submissions with a high rejection rate.
Research and investigate the reason for claim rejections, and notify management and providers on how to correct billing irregularities, and make recommendations on how to correct future submissions.
Responsible for all providers' EDI electronic file transmissions, assisting providers with various transmission problems.
Schedule and perform training for new and current providers.
Coordinate, and evaluate all providers' appeal request.
Respond to all incoming claims status calls via the provider claims hotline.
Inform providers of the status on paid, pended, rejected claims, and check status.
Educate providers on current or past changes to the National, State, and CBH guides, and billing manuals.
Coordinate efforts with internal and external resources to resolve providers claim.
11/27/00 to 3/4/2003
Integra Behavioral Health Inc
Customer Relations Liaison - Claims Resolution A
Answers inquiries from members, providers and patient representatives, regarding benefits, and eligibility, in a professional, and courteous manner.
Record inquiries and complaints following established guidelines.
Provide referral and authorization to providers seeking routine behavioral health services.
Direct crisis calls to appropriate units.
Complete daily, weekly and monthly reports accurately and in a timely manner.
October 1996 to May 2000
Benova Inc Philadelphia
Enrollment/Outreach Specialist
Provide education and enrollment for recipients, into the Penna.
Dept. of Public Welfare's HealthChoice's program.
Assist clients in enrolling into their Medicaid HMO's, and county Behavioral Health MCO, services.
Perform community outreach presentations to inform community organizations and providers of the full range of services provided.
Create and establish community and provider contacts.
Received and handled calls in a Call Center environment.
Educational Background
1987 Community College of Philadelphia Phila, Pa.
Business Admin
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