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Customer Service Medical

New York, New York, United States
November 29, 2017

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John Silvestry

*******st Street College Point, N.Y. 11356 Mobile phone: (718) ***-****

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To get started right away and make a difference. I have been in the claims insurance and customer service field for over 24 years. I am a self starter with common sense and considered a team player and by the book.

EXPERIENCE: 5/22/17- present FRESH DIRECT, LIC, N.Y.


Delivery of food and beverages to Corporate and Residential accounts. Scanning QA of all items on truck to assure all matches manifest and accounted for. Scans include in transit and at customer assuring deliveries are within window timely delivery per customer’s request.

2/09/98 - 7/8/16 SAG-AFTRA Health & Retirement Funds New York, N.Y.

Medical Review Analyst, Appeals and COB Specialist

Knowledge in all aspects of Benefits Operations such as claims, medical necessity review and eligibility. Responsibilities include analyzing complex health claims, making benefit determinations and investigating claim issues with participants, healthcare providers and external contractors. Review claims for over-utilization for cost-containment review related to CPT, HCPCS and ICD-9/10 codes. Negotiate prompt payment discounts for in-patient hospital claims. Coordination of Benefits and Appeals Specialist. Knowledgeable in Healthsuite, Benesys Systems, Suite Solutions, MDR Ingenix, Info McKesson, Pro-Conversion Systems, HIPAA compliance maintaining medical records and correspondence. Saved the Fund millions of dollars over the course of my years employed at the Fund. Helped in implementing new systems conversion updating business rules to reflect current Benefits Operations and educate Information Technicians/Data Application builders. Associate member with the Association of Certified Fraud Examiners.

1992-1998 : LUTHERAN MEDICAL CENTER Brooklyn, New York

Patient Service Associate/Medical Records/ Financial Counselor

Responsible for computerized appointment conversion for primary care, mental health and alcohol / substance abuse programs at a network site and supervised evening staff at another site. Duties include patient registration, medical billing, financial counseling (HMO managed care called Health Care Plus), ICD-9 & CPT coding, troubleshooting, cashiering and knowledge of DOS Tandem-PCS, MEDE systems and Microsoft Windows 3.1. Preparation of pertinent personal information, identifying and collating patient record. Provide executive administrator all statistical reports required in every aspect and categories in operations and possessing positive working relationships with clients, patients and all levels of upper management. Certified core team member for appointment systems conversion with Atwork Onecall.


2017 Completed 160 Driving Academy including Smith System 5 point driving

2011-2015 HIPAA Privacy Essentials (annual testing)

12/11/13 MHCD Examiner Training

11/14/12 Business Writing Workshop

2009 HIPAA certificate

5/98 Certified member of the Association of Certified Fraud Examiners, Austin, TX

1995-97 Center for Degree Studies/ ICS6/97 Certified in HBOC Pathways Systems, Minneapolis, MN

10/96 Certified in Customer Training Seminary

2/96 Certified in Atwork Advanced Onecall Seminary, San Jose, California 6/96 Certified in Atwork Onecall Database, Chapel Hill, North Carolina10/95 Certified in Simplified Medicaid Seminar, New York, N.Y

9/89-3/92 Emmaus Bible College, Folcroft, Pa.

9/80-6/81 Parsons School of Design, New York, N.Y

9/74-9/78 John Jay High School, Brooklyn, N.Y.

Served as Deacon at Bay Ridge Christian Center, Brooklyn, N.Y. counseling in Men’s and Prison Ministries since 1990 (individual/group counseling) termed in 2001. Additional references furnished upon request.

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