Claims Examiner, Customer Service, Medical Collector, Refund Analyst.

MARISSA MAARUP

**** * ***** ***** **., La Puente, Ca 91744 C: 626-***-**** ********@*****.***

PROFESSIONAL SUMMARY

Highly enthusiastic customer service professional with over 10 years of experience with claims adjudication driven to reach

company goals and maintain customer satisfaction.

SKILLS

Microsoft Office Word, Excel, typing 50 wpm Energetic work attitude

Knowledge of Microsoft Windows operating environment Courteous demeanor

10 key by touch Adaptive team player

Medical Billing and Collections Telephone Skills

Medical Terminology Time Management

Customer Service Strong organizational skills

Data Collection Sharp problem solver

Active listening skills

WORK HISTORY:

Grievances and Appeals Analyst I, 02/2015 to 07/2015

Anthem Blue Cross –Work at Home - CA

Reviewed assigned cases from member appeals and grievances by inputting into MAGI system.

Investigated and resolved all priority issues and/or concerns in a timely and efficient manner.

Composed acknowledgment letters, obtaining medical records as needed, resolved issues and ensured time frames are

met for acknowledgments and resolution letters.

Worked closely with internal departments to resolve and research member and provider reconsideration.

Contacted members, providers and external agencies to obtain additional information to adequately resolve and respond to

the reconsideration's and grievances.

Responded to any questions from members, family members, authorized representatives, providers and regarding

appeals and grievances.

Customer Service Associate III, 04/2006 to 02/2015

Anthem Blue Cross – Diamond Bar, Ca

Promptly responded to general inquiries from members, staff, and clients via mail, e-mail and fax.

Guaranteed positive customer experiences and resolved all customer complaints.

Responded promptly and resolved member inquiries and complaints.

Interacted with other departments as necessary to resolve issues.

Educated and communicated the benefit design packages to members.

Refund Analyst, 05/2004 to 04/2006

UCLA Patient Business Services –Los Angeles, CA

Reviewed credit balances and refund requests in a timely manner.

Followed refunds and reimbursement protocols for different payors.

After reviewing credit balances, refunded appropriate party according to contractual obligation or policy terms.

Reversed the over adjustments that created the credit balance or transfer existing credit to correct account.

Prior Authorization Intake Coordinator, 05/2003 to 05/2004

PacifiCare Health Systems – Cypress, CA

Inputted and processed authorization requests and auto authorization per guidelines and according to defined time and

accuracy standards.

Ensured correct and consistent application of decision support system.

Provided members with verification of eligibility and appropriate contracted provider/facility information.

Certified Medical Collector, 01/2000 to 05/2003

CMRE Financial Services –Brea, CA

Extensive billing and collection experience, including auto-dialer.

Knowledge of collection techniques and collection laws.

Knowledge of Social Security search, address search, credit reports, employment tracing.

Administrative Assistant III, 10/1994 to 02/2000

Physician Support Services –Los Angeles, CA

Over nine (9) years of medical claims examining Adjudicated professional and hospital claims for contracted and

non-contracted providers of UCLA Physician Support Services in accordance with claims policies and procedures.

Reviewed and processed all contracted capitated claims and fee-for-service.

Reviewed and processed claims acknowledgment, payment and denial as set forth by CMS, Healthplans and departmental

policy and procedures.

Recognized inappropriate CPT, ICD-9, HCPCS, and Revenue codes and accurately researched.

Alerted Claims Management of all claims issues that would impact any Healthplan compliance.

Billing Supervisor, 02/1986 to 10/1994

El Monte Medical Group –El Monte, Ca.

Ensured that daily work flow is smooth and billing is done on schedule.

Knowledge of Managed Care, Commercial Products, HMO, PPO, including electronic billing for Medicare/Medical and

Private Insurances.

Posted and adjusted payments received from insurance companies and members.

EDUCATION

Certificate in: Medical Billing/ Medical Terminology, 1986

Mt San Antonio College - Walnut, CA

Bachelor of Science: Business Administration, 1977

Philippine Women's University - Quezon City

Contact this candidate