Operations
Resume:
JOY A. SILVER
Upper Darby, PA 19082
***********@*****.*** www.linkedin.com/in/joy-silver-96aa0252http://www.linkedin.com/pub/joy-silver/52/a02/96a
http://www.linkedin.com/pub/joy-silver/52/a02/96a
http://www.linkedin.com/pub/joy-silver/52/a02/96a
Professional Summary
Over 14 years of successful experience as an Operations Professional. Resourceful expert with a blend of experience in analyzing, training, developing and managing projects, and customer retention. Possess exceptional leadership abilities in demanding work environments concerning team initiatives. Proven ability to leverage skills and capabilities to participate in all tasks while maintaining high standards and achieving company goals. Skilled in improving customer retention levels within highly competitive markets. Self-motivated, team player with the desire to succeed.
Professional Experience
Independence Blue Cross, Philadelphia, PA
Claims Payment Adjuster 11/2012 – 08/2015
●Team Leader functions to ensure that all task were handled in a timely manner.
●Liaison to Network Coordinators and Providers.
●Responsible for Running Reports for work specifics.
●Maintain inventory to meet and exceed corporate standards.
●Train employees and give feedback to the management teams.
●Manage and Coordinate projects; Communicate progress and changes to management teams.
●Quality Check processing and adjustment errors.
●Ability to provide quality customer support daily.
●Utilize policies and guidelines to determine claimant and provider eligibility.
●Utilized advance problem solving skills to provide effective results.
●Responsible for input of data that accurately reflects claim circumstances.
●Provide colleagues and providers with updated and reliable process information.
●Resolve escalated issues in a timely manner.
●Responsible for timely and follow-up request of all required medical records, documents, statements and claim adjudications.
●Handle complex codes and processing needs which include interacting with Support Teams to resolve processing problems.
●Assure that productivity and accuracy standards are established.
●Review and Process Foreign claims according to foreign policy guidelines.
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Claims Processing Analyst - Sr. Claims Processing Analyst 07/2007- 11/2012
●Provide support and training for associates to ensure compliance, and assist with on-the-job training of less experienced associates as assigned.
●Ran reports for work specifics and distribute to colleagues/management. Responsible for effective, accurate and timely review and adjudication of complex healthcare claims.
●Recognized for maintaining comprehensive knowledge of the claims processing and support systems.
●Research, review and resolve submitted claims following the appropriate guidelines.
●Investigate, document and resolve issues, including those of a more complex nature.
●Complete special projects and participate in and/or lead work groups as assigned.
●Track and trend issues and/or information as assigned.
●Work on multiple administrative systems in a task based environment.
●Interact with Support Teams to resolve processing and system problems.
●Work effectively with internal and external customers to ensure customer satisfaction.
●Operate within all company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.
Genex Services, Wayne, PA
Medical Billing Specialist 10/2004 – 07/2007
●Trained internal and external (out of state) employees to process claims.
●Quality checked processing errors.
●Monitor aging of assigned tasks to assure that assigned turnaround time standards are met.
●Maintained claims inventory to meet or exceed corporate standards.
●Handled complex adjustments and reconciliation request.
●Engaged in advance problem solving and provided knowledge for claims processing procedures and adjustments.
●Utilized analytical and problem solving skills.
●Specialized in Fee Schedule guidelines.
●Identified and resolved issues of concern both internally and externally.
●Made outreach calls to providers and customers.
●Assisted management with delivering quality customer service.
●Assured that productivity and accuracy standards were established.
Education/Professional Development
Strayer University
Bachelor Degree in Business Administration for Human Resource Management, 2012
National Society of Collegiate Scholars
Star Technical Institute
Computerized Medical Office Assistant, Diploma Awarded, 2001
Independence Blue Cross
Interned in the Human Resources Department of Benefits and Shared Services – 04/2013 – 06/2013
●Customer service access of Benefits.
●Investigate employee benefit issues.
●Update various databases which includes the retiree and grievance logs.
●Prepared materials for orientation.
●Prepared and filed new hire paperwork.
Skills
Type 45 wpm, Microsoft Office Suite, Peoplesoft, and Sharepoint, ICD-9, CPT Codes, Diagnosis Codes, SLIQ, MHS, Insinq, ITSM.
Community Service
Assistant Director - Catholic Youth Organization 01/2015 - Present
Hospitality Team Member - St. Cyprian Catholic Church 09/2013 - Present
References
Mark Gonzales - Director of Religious Education - 267-***-****
Melissa Sanchez - Supervisor at Independence Blue Cross - 267-***-****
Anita Wright - Site Assessment Coordinator - 215-***-****
Malika Speaks - Sr. Business Systems Analyst - 215-***-****
Dr. Bradley Brown - Retired Educator - 267-***-****
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