Insurance Data Entry
Resume:
KiShawna Wright
Houston, Tx 77073
Phone:713-***-****
E-mail: *********@*****.***
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
Contact this candidate