Customer Service Medical

MARY COLLEEN ROGERS

Email: ********@******.*** Cell: 443.994.423

SUMMARY OF QUALIFICATIONS

Extensive experience in Health Insurance Industry

Areas of expertise include:

Claims Adjudication, Medical, Dental, vision

Customer Service/Benefits

Medical Terminology/Medicare

Medical Coding/Dental Coding

Ability to Work Under Pressure, Adaptability, Multitasker

Time Management, Self-Motivated, High Interpersonal Skills

EXPERIENCE

Johns Hopkins Healthcare-Glen Burnie, MD

08/2010 – Present

Claims Examiner Level II

Handles aspects of maintaining and processing all lines of business, which includes Priority Partners Medicaid plan, USHFP and Johns Hopkins EHP employer health plans

Manage a 5 day turnaround time and maintain an excellent Quality Assurance of 99% financial and procedural

Prepare and Process Member reimbursement accounts

Prepare and review letters/correspondences that must go out to providers

Assist other departments with daily inquires

Upload claims into DocGem, Aerial, and price claims in 3M ASC Pricer daily

Informed-LLC-Annapolis, MD

10/2001 – 01/2009

Claims Specialist

Responsible for managing 10 group accounts for this Third party Administrator

Process all types of medical, dental and vision claims for large hospital clients (Anne Arundel Medical Center, PRMC, Frederick Hospital and Carroll Hospital)

Performed void and reissues of payments

Obtained PPO Discounts for out of state claims

Responsible for review of subrogation, pre-existing conditions, proof of student status, COB and verification of benefits

Acted as a Full Service Claim Representative on an as need basis.

Loomis TPA-Annapolis, MD

08/2009 – 04/2010

Claims Processor

Duties include processing medical and dental claims for Las Vegas Hotels (Winn Resorts and Venetian Hotel) at this satellite office

Assisted account executive with various duties

Mercy Hospital-Baltimore, MD

04/09 – 09/09

Billing Specialist

Duties include working from Excel spreadsheet to track records for expediting delinquent payments

Answered inquiries regarding outstanding bills which involved excessive research by reaching out to numerous Insurance companies on a daily basis that resulted in resolution of outstanding payments that were due to doctors who work for Mercy Hospital

In charge of creating frequent appeal letters that are submitted to insurance companies for review and reprocessing

Experienced and Knowledgeable with various types of medical plans such as PPO, POS, HMO, Indemnity, etc.

SKILLS

Microsoft Office, Word, Excel, PPT

Internet Explorer

Outlook Express

3M Pricer

Health Suite

Mc400

Rims

EDUCATION

PG Community College AA Degree

Anne Arundel Community College

Certification Excel, Word, Basic Computer Skills

REFERENCES

Furnished upon request

Contact this candidate