Customer Service Data Entry
Resume:
Lavonne Brewster
SKILLS AND QUALIFICATIONS
Dependable and efficient professional, dedicated to high quality customer service with the capability of working effectively within a team or independently.
Experienced Credentialing Specialist, Medical Biller, Claims Analyst, and collector
Proficient in MS Word, Excel, Outlook, Windows, Brightree, CAQH, Portico and 10-key typing
Customer Service, Credentialing, Malpractice Cases, Claims Analyst, Appeals, Payment Posting
Well versed in Provider Credentialing, Medicaid AHCA guidelines, DME Claims, EOBs, HCPC, CPT and ICD-9 codes.
Current regarding all Medicare CMS Guidelines
Received a certificate for HIPPA Privacy Regulations
EXPERIENCE
Credentialing Specialist
10/2013-PRESENT CENTENE SUNSHINE HEALTH SUNRISE, FL
Assist in the credentialing process to ensure timely enrollment for providers and facilities by obtaining the documents required by AHCA
Enroll providers with Sunshine Health using CAQH
Update Portico database with Providers’ current credentialing information
Identify providers with malpractice cases to present to the committee
Discontinue the credentialing process for providers not meeting requirements
Medicare Claims Biller
10/2010- 12/2012 LINCARE/OPEN-AIRE FT LAUDERDALE, FL
Submitted claims to the Brightree clearing house in a timely manner
Worked claim denials for all Medicare regions
Reviewed HCPS, CPT, and ICD 9 codes to ensure accuracy of claims
Resubmitted corrected claims within timely filing guidelines
Assisted with Worker’s Compensation appeals and reimbursements
Claims Analyst
6/2010-10/2010 HEALTH CARE SUPPORT STAFFING ORLANDO, FL
Verified patients insurance information and coordination of benefits
Ensured accuracy of DME claims to the clearinghouse
Notified and billed patient’s their out of pocket and coinsurance
Durable Medical Equipment Claims Analyst/Payment Poster
12/2006-3/2010 WALGREENS OPTIONCARE POMPANO BCH, FL
Worked on Medicare, Medicaid, Workers Comp, PPO, HMO, and commercial insurance claims
Reviewed contracts and fee schedules to assure claims are paid correctly
Reviewed HCPC, CPT, EOB’s and ICD9 codes to ensure accuracy of claims
Reviewed patient’s demographics to ensure accuracy
Submitted claims to secondary insurances
Posted Payments
Collector
5/2004-1/2006 BCC FINANCIAL FT LAUDERDALE, FL
Followed up on Denied Hospital and Physician Claims as well as Workers Comp Claims
Reviewed HCPC, CPT, EOB’s and ICD9 codes to ensure accuracy of claims
Third party biller to insurance companies including Medicare, Medicaid, HMO’s and PPO’s
Reviewed patients records to ensure all necessary documentation is on file
Successfully met goal by collecting on 50 accounts per day
Collector
4/2003-5/2004 TENET FLORIDA MEDICAL CENTER FT LAUDERDALE, FL
Followed up on denied Hospital Claims
Met or exceeded in claims follow up of 50 accounts or more
Reviewed HCPC, CPT and ICD9 codes to ensure accuracy of claims
Successfully coordinated denied claims that needed to be re-billed
Reviewed patients records to ensure all necessary documentation is on file
Data Entry/Customer Service
5/1999-1/2003 FOOD FOR THE POOR DEERFIELD BEACH, FL
EDUCATION
Broward College Coconut Creek, Fl (2 yrs)
Atlantic Vocational Technical Coconut Creek, Fl (1yr)
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