Pflugerville, TX *****
Seeking a challenging position for career advancement utilizing and strengthening my skills and knowledge. Strong self-motivation with excellent communication and organizational skills. Work Experience
Claims Service Specialist
Texas Municipal League IEBP - Austin, TX
October 2017 to July 2018
Attached to claims department answering incoming calls from providers and members concerning claim and EOB questions. These included medical,dental and vision claims. Knowledge of individual fee schedules and exclusions for each group were needed. Assisted in finding providers for members in their local area and starting the authorization process if it was required for particular services.
Claims Analyst III
First Care Health Plans - Austin, TX
January 2013 to September 2017
Firstcare Health Plans Processed Medicaid and commericial claims including COB, Ambulance, CHIP, DME and Home Health. Maintained status reports for member reimbursement and defaulted claims to prevent stoppage of claims payment process. Interfaced with other departments to resolve issues preventing payment of claims. Was assigned management of a virtual department of 6 processors that were located across the US. Was the contact person for questions and also randomly QAed their work.
Customer Sales Rep
Autozone, Inc - Austin, TX
January 2005 to December 2012
Cancer Claims Processor (Temp)
KForce Prof Staffing@GAFRI - Austin, TX
August 2008 to December 2008
KForce Prof Staffing@GAFRI
Processed supplemental health policies including:Cancer, heart attack, disability and catastrophic health plans. In addition to taking calls from policyholders and providers.
Prior Authorization Specialist (Temp)
November 2007 to February 2008
Handled provider calls regarding outpatient surgical procedures. Verified that procedures needed pre- auth and provider had all applicable information before routing to nurses. Matching incoming electronic pre-auth submissions to those already in the systems eliminating duplicates.
Affiliated Computer Services Inc - Austin, TX
October 2003 to January 2005
Processed Medicaid and Medicare crossover claims including appeals and claims with dual coverage. These included Medical,DME,CHIP and Home Health claims.
Corvel Healthcare Corp - Austin, TX
August 2002 to July 2003
Processing workers comp claims for multiple insurance carriers. Handled provider calls concerning billing and workers comp rules and regulations. Processed appeals and reconsiderations that required closer examination and investigation.
Health Claims Analyst
MediClaim, Inc - Austin, TX
2000 to 2002
Processed and validated Medicaid and Medicare health claims under State guidelines using Filenet imaging system.
Knowledge of medical claims forms, terminology, CPT, ICD-10 and DRG codes.