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Microsoft Office High School

Location:
Philadelphia, PA
Posted:
December 06, 2016

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Resume:

BLAKE A. LEE

Philadelphia, PA ***** 215-***-**** acxsgi@r.postjobfree.com

Summary of Qualifications

Proficient in Microsoft Office Suite and Epic system

Conscientious and thorough with detail

Self-motivated

Able to adapt to different situations

Critical thinking, decision making

Reputation for excellence and high quality service

Sharp quick learner willing to get involved

Organization and prioritization skills

Professional Experience

Holy Redeemer Hospital-Medical System / Robert Half Associates – Agency, Meadowbrook, PA 06/2016 to 09/2016

Financial Counselor/Temp position

Verifying patient’s coverage ensuring the referrals and authorizations are on account.

Counseling patients on out of pocket expenses (co-insurance/deductibles).

Contacting patients to revive outstanding balances and collecting co-pays from patients prior to date of service.

Utilize a financial clearance worklist to clear accounts.

The Sirrus Group/ The Preston Group – Agency, Oreland, PA 01/2016 to 03/2016

A/R Specialist/Temp position

Responsible for review and processing outstanding client accounts receivable as assigned.

Performed insurance verification as well as the preparation and submission of electronic and paper claims for various carriers including but not limited to governmental and managed care payers.

Reviewed payments from both remittances and explanation of benefits for accuracy.

Investigated and reprocessed denials and partial payments.

Prepared patient files verifying completeness and accuracy of information necessary for billing and payment.

GE Capital/ Lance Soft – Agency, Trevose, PA 11/2015 to 01/2016

Clerk III/Temp position

Responsible to investigating and adjudicating life claims against contract requirements.

Provided policy benefits to our insured’s/beneficiaries in compliance with policy language.

Made accurate and compliant decisions related to life claims adjudication.

Analyzed claims to determine eligible benefits through validation of policy status and policy language.

Evaluated information received and adjudicating claim, within authority level in accordance with the policy language.

AmeriHealth Caritas, Philadelphia, PA 11/2014 to 06/2015

Claims Examiner

Conducted timely investigation of moderate to complex claims to determine that costs are reasonable.

Maintained knowledge of applicable company policies and procedures.

Consulted policy files to verify information reported in a claim.

Checked applications for completeness and accuracy.

Responsible for on-going claim/case management and recertification of claim benefits.

Independence Blue Cross, Philadelphia, PA 05/1998 to 01/2014

Senior Claims Payment Adjuster 11/2008 to 01/2014

Claims Payment Adjuster 04/2003 to 11/2008

Claims Process Analyst 04/2000 to 04/2003

Claims Examiner 05/1998 to 04/2000

Investigated and resolved healthcare claims by verifying charges, determining eligibility, documenting findings, and updating records.

Verified information from claimants, physicians and medical providers to assess compensability and make evaluations.

Investigated and verified valid and accurate insurance coverage.

Reviewed and analyzed members benefit package to ensure claim was processed accurately.

Maintained productivity standards to ensure timeliness, efficiency and effectiveness.

Education

Martin Luther King High School, Philadelphia, PA

High School Diploma



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