Customer Service, Microsoft Office, medical terminology, medical codin

Lelith V. Sharpe-King

347-***-**** **********@*******.***

SUMMARY OF QUALIFICATIONS

•19 years of experience in healthcare administration and customer service

•Extremely well-versed in ICD 9/10, CPT codes

•Highly educated in claims processing, insurance verification, prior authorizations, billing discrepancies, EOBs/EOPs, physician credentialing, fee negotiations and HIPAA

•Proficient with Microsoft office, QNXT, Med-ware billing system, WC and no fault

PROFESSIONAL EXPERIENCE

Utopia Claims Concepts 2/2015/-12/2015

IME Coordinator

Scheduled independent medical evaluations for worker’s compensation and no fault claims

Maintained physician’s appointment log

Coordinated transportation and interpretation services for claimants

Recruited and credentialed new physicians to the panel

Billed insurance carriers for services rendered.

1199 SEIU Benefit and Pension Fund - New York, NY

Billing/Fee Negotiation Coordinator 4/2008-6/2010, 1/2012-5/2014

•Negotiated fees for services rendered by non-contracted providers

•Redirected HCFA/CMS 1500 and UBO4 claims to appropriate departments for processing

•Assisted providers with correction of billing/coding errors, claim appeals and claim submissions/resubmissions

Quality Control Reviewer PR Call Center 4/2005-4/2008

•Provided training and assistance to customer service representatives

•Provided information regarding, claim status, member eligibility/benefits, and prior authorizations

•Resolved escalated claim disputes and provider inquiries

Hospital/ Medical Claims Processor 7/2002-4/2005

•Reviewed hospital/professional claims for correct coding and billing

•Processed UB92 and HCFA 1500 claims according to patient eligibility, procedure approval and fund’s policy

Local 1115 Benefit and Welfare Fund - Westbury, NY

Pre-Certification Specialist 3/1999-7/2002

•Coded and issued referrals and prior authorization for diagnostic and surgical procedures

based on physician requests

•Coordinated and authorized discharge planning for patients released from hospital care

•Coordinated and authorized outpatient mental health services.

EDUCATION

•2011-University of Phoenix, Phoenix, AZ – Associate’s Degree, Psychology

•2016-NLBI Institute, Jamaica, NY – Medical Billing/Coding Certificate

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