Insurance Responsible
Resume:
Mark Antony Spires
Sterling Heights, MI. 48310
****************@*****.***
Objective: To obtain a secured position that will allow me to utilize prior knowledge while gaining additional skills, allowing for career and professional growth. To apply my driven desire to succeed with elevating a good company into a great one.
Employment:
09-23 to Current EHIM (Employee Health Insurance Management)
Work Compensation/Auto Team Member- Responsible for working with clients to evaluate utilization to achieve their goals and select programs to fit their organizational needs. This includes customizing specific plans for each of a client’s organization. Responsible for invoicing, approving, and/or denying paper bill requests sent in by the client or their members. This also includes responding to inquiries regarding insurance availability, eligibility, coverage, and plan.
04-11 to Current Mclaren Hospital (Emergency Department)
Ward Clerk-Responsible for registering patients upon arrival. Responsible for accepting initial complaints and entering into Paragon System. Responsible for entering orders from staff doctor including labs, physicals and shots. Responsible for admitting patients at on-site hospital or contacting EMS to transfer patient. Responsible for creating daily on call scheduling for on call doctors.
05-10 to 09-13 Primis Healthcare Systems Inc. (DME)
Reimbursement/Patient Access Specialist- Responsible for compiling data to obtain secondary insurance, allowable, and payments. Posting Ability Network Reports and accessing Web-Denis. Verifying Insurance using Medicare Ability Reports or WEB-DENIS for commercial insurances. Responsible for reporting all denials or prior paid claims. Responsible for clean claim submission, and correcting returned claims due to errors. Creating and entering Certificates of Medical Necessity. Search patient’s accounts for accuracy entered by CSR’s and professional technicians. Enter and Key new accounts and supply patients with equipment upon discharge from professional office, hospital, or nursing facility.
06-08 to 05-09 IBM Corporation (Yellow-Belt-6 Sigma)
Reconciliation Specialist/Goodwill Analyst- Responsible for analyzing, transmitting and approving reimbursements for customers. This includes daily overseeing approved amounts to satisfy the program objectives.
05-02 to 06-08 FlexBen Corporation (Banking)
Production/Auditor- Responsible for daily run of great volumes of check processing.
This includes pulling computer generated files. This position uses daily balance
sheets to account for all outgoing processing. This function is a banking function which
allows the corporation to have accurate and precise daily records and funding.
2008Macomb Community College
Clinton Township, Michigan (Center Campus)
Patient Access/ Accounting Specialist Program
CHAA/CPAT Exam Credentials
Program Completion- March 2009
2003 Detroit College of Business (Davenport University)
Dearborn, Michigan Bachelors of C.I.S. and Business
References Upon Request
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