Healthcare benefits administrative specialist
Resume:
Kim Buchholz
El Mirage, Az 85335
********.*.********@*****.***
Career Summary
I am professional, motivated, dedicated, with healthcare insurance and business administration experience. I have leadership skills, organizational management, and have utilized strategic planning to prioritize the workload. My knowledge and work history has given me practical experience as well as allowed me the ability to focus on interpersonal skills leading to team collaboration which synergistically empowers productivity.
Programs/system utilized with Work History
Word, Excel, Sales Force, Market Prominence, Share Point, Cloud, EHR- EMR, Centricity, Next Gen, Passport, I-Terminal (computerized payment systems), Citrix, Avaya, Care One, CCS systems, Multiple phone-lines, Electronic Fax systems. FEMA flood system,
POS.
Work Experience
MEMBER BENEFITS ADVISOR AGIA
08/14-03/15 Scottsdale, Az
Assisted with policy, benefit information, general claim filing information regarding supplemental plans: AD&D, Term-life, Disability
Created new member benefit accounts as a result of marketing and product offer solicitation
Initiated escalation to prioritize the customer’s request
Utilized on-line banking system
Advised of rates for premiums to groups such as: GSC, AOPA, LIT,NRA
SALES COORDINATION/CLERICAL ADMIN/PFS BANNER HEALTH-Staffing 07/13-06/14 Mesa, Az
Accessed patient/client account to initialize the processing of Medicare applications within informational guidelines for BCBS Advantage
Filing, completed fulfillment requests
Processing electronic payments, Physician’s order tasking, scheduling appointments while accessing appropriate EMR systems
CARE COORDINATION/CLINICAL MEDICAL ADMIN. UNITED HEALTH GRP 03/06-10/06//04/09-5/12 Phoenix, Az
Worked with business affiliates to complete accurate documentation of records and updating patient information for notification purposes Commercial division
Utilized Care Management systems and tools for processing notifications
Learned HIPPA laws, and received fraud training in compliance with corporate guidelines
Approved DME, HHC: products/services for Medicare Advantage (Medicare Complete/Secure Horizons division)
Triage calls to appropriate care management function as well as accessed notification wizard to verify ICD-9 and CPT coding when applicable for notification
ADMIN. ASSISTANT/ FRONT OFFICE ADMIN DESERT STATE APPRAISING
04/05-11/05 Peoria, Az
Maintained A/R and billing for over 13 business affiliates
Created electronic accounts using computer systems, as well as creating and maintaining hard copy files
Managed phone systems, customer accounts, scheduling, office supplies, inventory and filing
Achieved a high level of accuracy in processing of documents and correspondence while maintaining a high production volume in a fast paced, demanding work environment
TEACHING ASSISTANT CATHEDRAL CHRISTIAN ACADEMY
03/04-04/05 Glendale, Az
Responsible for maintaining order in the classroom setting
Set up play stations, and oversaw students in social interaction with one another
Assisted with documenting growth and progress of each individual student
BENEFIT VERIFICATION SPECIALIST PRINCIPAL FINANCIAL GROUP 05/02-02/04 Phoenix, Az
Accessed personal and confidential information pertinent to updating systems
Verified benefits for various insurance policies to policy holders or medical affiliates
Assisted with the submission of claims, predeterminations, and appeal process
RETENTION/CUSTOMER SERVICE DISCOVER CARD
10/01-05/02 Phoenix, Az
Consulted with clients, while retaining and setting up customer accounts
Daily duties consisted of assessing strategies to offer optimum customer assistance and service in diverse situations
Negotiated rate reductions where applicable
Implemented sales and product promotion
Routed misdirected calls to the correct department to fulfill the customer's needs
Education: AIBT-Medical Assistant Administration; Service Training for Retention at Discover Card included Credits through Rio Salado College
Contact this candidate