Customer Service High School

Oletha Lyte

****A O'Fallon - St. Louis, MO *****

******.******@*****.*** - 314-***-****

WORK EXPERIENCE

Quality Review Auditor

Cigna - St. Louis, MO - August 2011 to Present

Audits and corrects claims pulled for Pre-pay review in a timely manner with consistent high quality

• Ensures compliance with plans, policies and procedures, account benefits, and contractual terms

• Assists in developing edit data requirements and able to identify claim error trends and causes based on

claim audits

• Review/test/validate query logic results with Project Analyst prior to an edit going into production

Claims Analyst/Customer Service

Mercer Administration - St. Louis, MO - January 2006 to January 2011

Processed high dollar medical claims, appeals, pre-authorizations, and adjustments

• Managed large case files and reports

• Handled enrollments in a call center environment

Intake Coordinator

Insurance Overload System - St. Louis, MO - May 2005 to December 2005

Handled incoming calls from providers and members in a call center environment

• Discuss member benefits and coverage, authorized mental health and substance abuse visits

• Handled crisis calls

Customer Service Rep

The Epoch Group - St. Louis, MO - January 2000 to February 2005

Handled incoming calls in a call center environment

• Explained medical and dental benefits, checked claim status, and resolved claims issues

• Assisted other departments with overpayments and collections

EDUCATION

Certificate in Patient Accounts/Medical Billing

St. Louis College of Health Careers - St. Louis, MO

1991 to 1992

High School Diploma

Health Careers High School

1991

SKILLS

ICD-9 and Cpt Codeing, Insurance Medical Terminology, Insurance Verification, Proficient in MS Excel, MS

Word,Enrollments,Collection,Claims Appeals and Denials

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