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Administrative Assistant Medical

Eloy, AZ
November 20, 2018

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**** **** ****** **

Eloy, AZ *****

Ph 520-***-****


Self-motivated, intelligent, and conscientious individual seeking a challenging and rewarding management position. Team oriented individual, bringing valuable assets including knowledge, supervisory and organizational skills, ethical and professional standards. Solid working knowledge around multiple health plans.


Associate of Business Science Degrees, Beal College, Bangor Maine

Medical Office May 1997

Medical Administrative Assistant May 1997


Medical Terminology Human Resource Management

General Pharmacology Medical Ethics and Law

Medical Office Procedures Accounting I and II

Computerized Accounting Creating Member Profiles

CPT/HCPCS/ICD9 Microsoft office Live Meeting

Microsoft Office Communicator Loading Authorizations

Loading Provider Contracts Processing 1450 and 1500 Medical Claims

Loading Authorizations 10-Key

Teaching how to process Medicaid, Medicare, Commercial, Dental and ALTCS claims

System Proficiencies:

Case Trakker Predictive Pathways’ Module

Microsoft Office Suite iLinc

Medisoft Software iHealth (Claims Inquiry Tool)


ProPat Windows

ABF (Client Access System) Encoderpro

Alchemy EDI Claim Lookup

Medical Business Unit Portal Dynamo

Snagit 10

Work Experience:

AZ Department of Corrections, Florence Complex (Corizon Health/ Wexford Health Source), ASPC -Florence, 1305 E Butte Ave, Florence, AZ 85132. {NCCHC accredited prison, in July of 2012 Wexford Health Source received a contract for providing the prison health care system, in Arizona as of March 2013, the contract was awarded to Corizon.}

Administrative Assistant 10/2012-Present

Responsible for HR duties which include Payroll, time details, missed punches. In addition, ordering medical and office supplies for all Florence prison units, coordinating meetings and various projects, ID badges, fingerprints. Processing background clearances. Entering I9 Express validations.

Aetna 4645 E Cotton Center Blvd, Phoenix, AZ 03/2001-09/2012

Claim, Provider and Special Services learning and Performance Team Trainer 12/2007-09/2012

Responsible for teaching core Skills, Advanced Research, and all plan specific courses for the commercial, Medicaid and Medicare claims. I actively work production Medicaid/Medicare claims in an effort to make sure I remain an expert at claim resolution. Also responsible for creating training materials such as practice claims and learning tools, edit authorizations, and create member records for exercises. I peer review many procedures related to the resolution of various claim issues. Responsible for auditing 100% of trainee claims for accuracy and proficiency for health plan specific certification.

Call Center Trainer 07/2007-12/2007

Educated associates with various commercial, Medicaid and Medicare plans. Instructed on the process of QNXT and QMACs applications. Taught how to use the Interaction Fax, Interaction Client, Encoderpro and Outlook. Help create the instructional books for each plan and application using the pdf format. Assisted in resolving detailed and escalated issues.

Care Coordinator, Case Management: 09/2006-06/2007

Interacted with facilities, provider’s offices, members and co-employees. Assisted in the training for the Case Management staff pertaining to call tracking, Case Trakker, Outlook and QMACs. Completed Provider Nomination forms. Assisted members and providers with escalated issues, ranging from claims to authorizations. Assist Self-funded commercial Plans with Authorization issues, claim issues, Provider issues and member complaints.

Provider Information Specialist: 08/2005-09/2006

Loaded contracts. Interacted with other organizations concerning contract issues. Processed claims that were sent to the Provider Information Management department. Recognized claim errors and/or processed. Developed good rapport with Provider Relations for various Medicaid plans.

Prior Authorization Representative: 03/2001-08/2005

Assisted employees on a daily basis with mentoring, as a level III, in the Prior Authorization Department. Assisted members and providers with escalated issues, ranging from claims to authorizations. Loaded authorizations for review. Finalized requests for medical and DME authorizations. Did overrides for Pharmaceutical Prescriptions. Reviewed clinical information for outpatient procedures for approval. Triaged incoming faxes.

Express Scripts Inc., 1700 North Desert Drive, Tempe, AZ 06/1997-03/2001

ASC Team: 06/1997-03/2001

Trainer Blue Shield of California, and the Help Desk Associates in various programs and protocol.

Help Desk Mentor: 06/1997-03/2000

Assisted in adjudicating claims online with pharmacies all over the country. Mentored the pharmacy customer service dept. Reviewed and processed claims for the claims dept under a certain dollar amount to credit members on pharmaceutical mail order issues. Overseen employees as a mentor. Educated and guided co-workers. Overrode authorizations for the prior auth dept to allow medications to pay, if criteria was met. Loaned out to the Zeneca Program for Women with Cancer getting medication at no or little cost to them.

References available upon request

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