Customer Service Data Entry

Aisha Adams-Adelekan

************@*****.***

919-***-****

HIGHLIGHT OF EXPERIENCE

. Customer Service

. Database Management

. Medical Claims processing

. Billing and Recovery

. Accounts Receivables

. Appeals/Grievance resolution

. CRM

EXPERIENCE

Delta Dental (2013)

Claims Analyst II (Contract)

. Performed data entry of claims into an electronic claiming system.

. Authorized claims and ensured all information is processed accurately

and in a timely manner

. . Entered, recorded and tracked data entry claim receipts using an

excel spreadsheet.

. Accessed and utilized department mail, count mail, stamp and date.

Scanned claims after payment processed.

. Adjudicated dental claim at 98% accuracy

. Interacted with management on workload, issues and backlog

Healthcare Unlimited (2010-2013)

Billing/Claims Team Lead

. Processed Medicare Part C claims for Durable Medical Equipment and

home hospice services

. Appealed subrogated claims

. Posted payments and worked denials

. Collected payment via third party insurance providers (Tricare, UHC,

BCBS)

. Audited claims for all accounts requested by lead claim analyst

. Resolved outstanding aging balances for all accounts

. Followed up appeals and claims adjudications

Blue Cross Blue Shield of NC (2008-2010)

Benefits/Claims Analyst

. Conducted open enrollment for medical benefits

. Investigated information related to coordination of benefits, during

appeals process

. Issued benefits verification to providers and members

. Provided assistance with, claims processing and self billings of

insurance

. Verified the calculation of the monthly premium statements for all

individual /group insurance policies

. Maintains data relative to premiums, claims, and costs

. Followed up with peer to peer review during appeals process

. Processed medical claims of Commercial and Blue Cross claims with

special emphasis on inpatient accounts.

. Recovered overpayments

.

Blue Cross Blue Shield of NC (2006-2008)

Intake Specialist

. Communicated client specific clinical information to insurance company

case managers for the specific purpose of obtaining appropriate

authorization to treat, and continued stay authorization.

. Gathered data about client from intake department and clinicians

. Interpreted data and investigating all dimensions of patient clinical

criteria

. Assessment of appropriate level of care

. Interacted with insurance company for authorization to treat

. Coordination with intake and billing departments

Alpha Omega Healthcare (1998-2006)

Claims /Billing Analyst

. Reviewed all revenue cycles during prior to auditing stage

. Assisted with the review of all delinquent accounts, and reported to

credit bureau as needed

. Identified errors in arithmetic, data entry or procedures prior to

submission

. Performed billing and reconciliation activities

. Exercised strong interpersonal communication skills with customers and

department personnel

. Collected payment for services via phone (SIEBEL BUY ONLINE) or

REALTIME collection systems

. Prepared accurate billing and reconciliation reports as requested

EDUCATION

BA, Business Administration: BS, Healthcare Management 2010

Mount Olive College, Mount Olive, NC

SQL Administration : Certificate 2012

Unitek College, San Jose,CA

TECHNOLOGY

Programs: Word, Excel, PowerPoint, Lotus Notes, Visio

Applications: EXCEL, InDesign, Microsoft Project, Patient Management

System (PMS), North Carolina Access, MECCO, MED3000 Billing, Allscripts

Solutions

Language: SQL, Microsoft Office Suites

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