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Healthcare Support

Location:
Jacksonville, Florida, United States
Posted:
August 25, 2018

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Resume:

Joanna Chila (Jodi)

***** ****** **.

Jacksonville, FL 32218

904-***-****

ac6s44@r.postjobfree.com

Objective: To obtain a position where my skills will be of value while continuing to expand my knowledge.

Experience

2003 - Current Florida Blue Jacksonville FL

Customer Service Representative

●Subject Matter Expert to Florida Blue ACS Partners.

●Proficient in Seibel, Diamond, Convergence, Quest, Availity, JIVA ARCHER, SAP and People Soft systems.

●Process written communication and handle phone requests from Florida Blue providers on a daily basis.

●Trained in Local Plans all lines of business), NSA Accounts, Medicare Advantage HMO & PPO Plans and Medicare Supplemental Plans

●Handle a high volume of phone calls while maintaining quality, productivity and availability.

●Researching and providing status on claim processing, payments, denials and adjustments in accordance with the member’s benefits

Health Insurance Caseworker

●Responsible for updating eligibilty according to files received from the Healthcare Marketplace

●Calling the member for every case received from the Marketplace and keeping them informed or the status

●Familiar with the different tiers of insurance provided by the government

●Responding to every case outlining all updates

Strategic Provider Advocate

●Outbound Service Advocate for Strategic Provider Services. Responsible for assisting high volume provider’s with their Accounts Receivable

●Processing new claim entry and claim adjustments

Appeals Associate IVa

●Triage and process associate level provider appeals, assigning extensive clinical review appeals to the appropriate nurse

●Ensuring all state and federal guidelines are followed and claims have been adjudicated according to Medicare guidelines

●Responding to appeals within the required time frame, avoiding any out of compliance appeals

●Knowledge of CPT, HCPCS and both ICD 9 and 10 codes

2002 - 2003 Mayo Clinic (TRC Staffing) Jacksonville, FL

Patient Account Representative

●Work with multiple insurance carriers daily to resolve claims with open balances.

●Review Florida Blue and Medicare accounts for accuracy after they were referred to the insurance department.

●Review Florida Blue EOBs and submit additional information as needed.

●Proficient in Powerchart, MRMS, Application Extender and PPP.

1998 – 2002 Aetna U.S. Healthcare Jacksonville, FL

Sales Support Specialist

●Paid commissions to brokers for healthcare policies. Provide detailed commission audits to brokers as requested.

●Set up small group health insurance policies. Enter renewal rates for group policies.

●Daily phone contact with internal and external customers.

●Daily use of Microsoft Word, Excel and Access as well as e-mail.

1997 - 1998 Aetna U.S. Healthcare Jacksonville, FL

Eligibility Technician

●Validate and enroll newborns in Medicaid.

●Review tape fees from billing department to verify eligible employees.

●Make policy changes as requested by members.

●Maintain quality and productivity while answering inbound customer calls.

1989 - 1997 Prudential Healthcare Jacksonville, FL

Large Group Commission Specialist/Billing Representative

●Input commissions for large group policies. Maintain these records to provide annualized commission statements. Transition commissions to PA office.

●Balance commissions versus monthly premiums.

●Bill and reconcile large group health policies.

●Conduct written and oral communication with brokers and policy holders daily.

●Train new employees as needed.

Education

1985 – 1989 Andrew Jackson Senior High Jacksonville, FL

●High School Diploma



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