ONDRA MOODY

**** ***** ****** ****** ************, Pa 19123

Phone: 267-***-**** Email: acwpry@r.postjobfree.com

OBJECTIVE

Efficient, dependable and versatile Healthcare Management Professional aspiring to obtain a challenging position within the company that will allow for professional and personal growth.

AWARDS AND SKILLS

Management:

•Award recipient of the Outstanding Achievement Award, winner of the Gold Award of Excellence and the AmeriHealth Quality Service Award.

•Holding multiple certificates in Valuing Team Diversity, Records Retention Training Program, Medical Test and Signs, Interpreting Medical Reports, Coordination of Benefits Training as well as, Ethical Awareness and Decision Making.

•Proficient with Microsoft Word, Excel, Outlook and other internal operations systems and office equipment.

•Ability to interact effectively with Providers/Partner Plan Staff at all levels and across all departments.

•Excellent verbal and written communication and analytical skills along with, being detailed oriented.

•Capability to organize time effectively to meet responsive turnaround times while successfully being able to prioritize, analyze and problem solve.

•Understanding of products such as Medicare, Medicaid, Personal Choice OOA as well as Individual products.

•Knowledge of HCPCS Coding Guidelines, ICD-9 and CPT codes, ambulance coding and DRG pricing.

Communication and Leadership:

•Responsible for monthly Escalations Report Meeting and Bi-weekly conference call meeting with Horizon BCBS.

•Appointed as Super-user by IBC for Transformation to High-Mark Blue Shield claims system. I also was liaison between the companies for training and development and assisted management with associate Q&A.

EXPERIENCE

PATIENT ACCESS REPRESENTATIVE CAREERS USA 07/16-08/16

•Responsible for handling all incoming call for Penn Medicine from start to finish.

•Scheduled appointments for Students and Resident dentist at Penn Dental School.

•If patients were not registered in UPHS system, I had to register them utilizing the AXIUM & Epic System.

•Access patient's insurance information to confirm their eligibility before scheduling appointment.

•Interpreting test results and giving directions to UPHS healthcare facilities and calling in prescriptions.

INTER PLAN RELATIONSHIP COORDINATOR INDEPENDENCE BLUE CROSS 11/13-03/15

•Resolves common, complex and escalated issues directly impacting Provider and member claims by working with other BCBS Health Care Plans.

•Tracks inquiry information and providers root cause analysis, reports to Management to enable issues addressed at a National Level.

•Partners with all areas of company in order to achieve timely issue resolution and compliance with other BCBS Health Care Plans servicing requirements.

•Identifies, fixes and eliminates “operational” issues that are identified as Trends/patterns of untimely, inaccurate, noncompliant or inconsistent claims adjudication for our providers or partner BCBS Health Care Plans.

•Manages open inventory both onsite and offsite to meet stringent BCBS Association requirements.

•Receives tracks and researches escalations for timely resolution in accordance with BCBSA escalation guidelines.

•Precisely completed appropriate claims paperwork, documentation and system data entry.

SR. CLAIMS PROCESSING ANALYST (SME) INDEPENDENCE BLUE CROSS 12/07-11/13

•Responsible for handling all IPPO Home Original claims from Administrators, members and or providers. All aspects of front end processing.

•Trained in OOA pricing. Ambulance, DME, Inpatient, Outpatient and ER claims.

•Coordinating benefits with other insurance carriers for OPL and Foreign claims for all lines of business.

•Utilization of various systems to investigate, obtain and record claims Information. Systems are MHS, Oscar, SLIQ, ITS, Mainframe CIS web 2.0, Blue Squared, and Max MC.

•Research claims issues and accurately process in a timely manner.

•Resolved suspended claims issues, pulled from reports and spreadsheets for all lines of business.

MANAGED CARE CLAIMS COORDINATOR INDEPENDENCE BLUE CROSS 02/06-12/07

• Responsible for handling Local claims and accurate timely adjustments of complex facility, professional and ancillary claims that are submitted by members and or Providers.

•A comprehensive knowledge of IBC operations including claims processing, medical policies, Personal Choice, Keystone HMO policy and procedures.

•Respond professionally to external/ internal inquires via Excel spreadsheet and mail correspondence. Maintaining and departmental standards on MHS and Plan-mate systems.

•Research and investigate complex and high dollar adjustment.

•Requests received from all areas inclusive of internal and external sources (e.g. other plan providers) as required.

•Preform executive inquiry for member or provider payable claim payment adjustments.

SR. OPL RECOVERY SPECIALIST INDEPENDENCE BLUE CROSS 04/00-02/06

•Determine and analyze Other Party Liability through Investigation and research.

•Coordinate benefits for Motor Vehicle Accident, Worker’s, Comp, Slip and Fall claims for KS-65, AmeriHealth-65 and PC-65.

•Review Letters of Exhaustion from auto insurance carriers; adjust any denied claims submitted before the letter of exhaust.

•Calculate specific charges and dates missing from Letters of Exhaustion.

•Daily responsibilities are processing, adjusting and updating the member’s insurance information via EOB documentation, MHS, IBC mainframe and data entry on spreadsheets.

•Meticulously identified and rectified inconsistencies and discrepancies in medical documentation.

EDUCATION

Community Collage of Philadelphia – Associate degree received in 1984 with a major in Fine Arts and minor in Art History.

REFERENCES

Available upon request

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