KiShawna Wright

***** ******* **** **

Houston, Tx 77073

Phone:713-***-****

E-mail: acwfbh@r.postjobfree.com

Professional Summary: I have over 7 years of experience in the healthcare industry including experience in billing, insurance verification, claims processing, denials, and prior authorizations. In past positions, I have reviewed, researched, investigated, negotiated, and resolved various types of appeals and denial statements for both members and providers. Additionally, I have examined and replied to letters of complaints. I have extensive knowledge of CMS guidelines, HIPAA Privacy Laws, DENALI medical records, and maintenance of electronic medical records.

Education:

Bachelor of Science Degree in Healthcare Services and Management – University of Phoenix

Master of Science in Healthcare Administration- Kaplan University (Projected Date of Completion 2017)

Professional Experience:

Aon Hewitt Houston, TX

April 2015 – Present

Customer Advocate

Handle incoming calls from clients’ employees, answer questions, and clarify concerns regarding healthcare benefits, 401K savings, life benefits, retirement plans and other human resource related services

Navigate a Windows based system through a series of databases in order to access the appropriate information to service the customer

Work on various administrative projects which can include benefit calculations, data management, transaction workflow call backs, and process improvements

Manage Birthday Club Committee

United Health Group

September 2013 – December 2014 San Antonio, TX

Clinical Appeals Representative

Processed appeals of denial claims

Examined and replied to letters of complaints

Processed claims

Communicated with appropriate parties on concerns, implications, and decisions

Provided expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances

Analyzed and identified trends for appeals and grievances including Senior Level positions with education, certifications and licensures other than an RN, such as BSW, MSW, DDS, Chiropractor, or Physical Therapist

Brident Dental & Orthodontics

May 2013 - September 2013 San Antonio, TX

Patient Care Coordinator (Contract via Staffing Agency)

Greeted patients and checked patients in/out using data entry

Scheduled patients appointments

Answered and responded to telephone calls with professionalism

Verified insurance plans and benefits

Collected payments from patients at the time of treatment

Sent preauthorization/referrals to insurance companies.

Verified and updated patient information

Blue Cross Blue Shield

August 2012 – May 2013 Tulsa, Oklahoma

Customer Advocate (Contract via Staffing Agency)

Responsible for managing high call volumes

Pre-authorizations of inpatient and outpatient, input CPT codes and procedure codes, and reviewed records for completeness, accuracy and compliance with regulations

Processed patient authorizations and discharge documents

Worked with various lines of business such as CDHP, Medicare and Medicaid, and wellness and disease management

Knowledge of medical terminology and anatomy

Attached clinical information that has been faxed into patients accounts (indexing), creating pre-authorizations based on the information faxed in from providers

Insurance verification experience

Knowledge of various payers and payer insurance cards

Certification and Licensure:

CPR Certification

HIPAA Certification

References upon request

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