Aleah P. Mullins

Provider Data Management Expert 314-***-**** ad28jh@r.postjobfree.com

PROFILE

Experienced and driven Data Analyst with an impressive background in managing mass amounts of data while providing analysis and support to develop/redevelop department structures. Worked to locate and correct errors to ensure proper payment of claims by following trends and forecasting future errors to prevent errors in claims processing, payment, and system databases.

SKILLS

• ICD-10 • Microsoft Excel • Research • Customer support • Data entry • Insurance verification • CPR • Communication skills • Behavioral health • Member Enrollment • CPT coding • Auditing • Medicaid/Medicare/Marketplace knowledge • Jira

Employment History

Customer Data Service Representative United Healthcare St. Louis, MO September 2021 to Present ·

Respond to telephone or email correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources

Aid members and/or providers regarding website registration and navigation

Document all activities for quality

Process written customer correspondence and provided the appropriate level of timely follow up

Coordinate member transportation and make referrals to other departments as appropriate maintain performance and quality standards based on established call center metrics including turnaround times

Ensure pharmacy orders and invoices are distributed appropriately to patients and physicians, input patient information into billing systems

Research and identify any processing inaccuracies and route them to the appropriate site operations team for claim adjustment

Responsible for various activities related to the provider network database: database maintenance, reporting and extracting data for various reports and analyses, initiating database improvement.

Developed and maintained standards for database integrity and quality assurance, coordinate corrective activities to clean database and retain users, and manage communication processes with other departments regarding database improvements.

Conducted claims auditing to ensure accuracy of payment and quality assurance

Provided feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network

Represented the provider network area on company IT projects, reporting and tracking provider calls and complaints, or for the support, coordination, and production of the paper directory cycles.

Workers Compensation, Medicare, Medicaid, CPT, ICD-9, and HCPCS educated

Responsible for processing claims and apply the appropriate provider contract for payment.

Responsible for assisting with Supervisor calls as well as monitoring other representatives calls and quality

Provider Data Service Representative: Magellan Health Services - St. Louis, MO October 2017 to April 2021

Enroll providers and practitioners into the provider data management system

Update provider and practitioners with claims payment and directory information

Research, review, and make updates within the provider data management system per provider requests

Perform quality service checks on systemic data, inclusive of claims processing and provider directory information

Perform research and resolve all arising issues

Use of Excel to perform batch loads, using concatenate and vlook ups

Completed intake prior authorizations for substance abuse and behavioral health

Account Representative GC Services - Saint Charles, MO May 2017 to October 2017

• Verify correct account information with the Credit Bureau

•Maintain attentive and prompt customer service relations with client and client customer's

•Documents all customer contact activity in various client systems in a concise and accurate manner

•Cope with high-stress environment caused by speaking with emotional caller •Adhere to Company attendance, punctuality, and meal and rest break requirements •Maintain concentration and focus to meet performance goals

•React positively to an ongoing, changing environment

•Demonstrate the ability to handle pressure when attempting to meet deadlines and performance

•Perform additional duties as required by management

The Outsource Group, Saint Louis, MO

Accounts Receivable Aug 2014-Sept 2015

Responsible for posting payments to various accounts

Handling low dollar and high dollar accounts for various facilities

Reviews all billed initial claims for accuracy and completeness before submitting for payment

Submits electronic and/or hardcopy claims with any attachments as per the contract timely filing criteria

Documents all account activity in the hospital system notes and the database

Contacts the health plan by phone or website to determine status of claim

Documented all follow-up inquiries in the hospital database

Review reasoning for non-covered claim, resolve the claim

Trained on systems Epic, Artiva, FL Medicaid, Tableau, Onbase, Concuity, Availity, OnBase, and Lawson

Trained with ICD-10 and DRG

Trained on State of Florida Medicaid

Responsible for ensuring accurate claims payments

Review 100% of all claims paid with amounts greater than $25,000 to confirm that they are correctly adjudicated prior to payment.

Reviews a random sampling of all electronic claims processed in the previous week to verify Procedural, Payment and Financial accuracy.

Reviews all 1500 claims paid with exact duplicate lines to confirm that the system edits are working appropriately according to DOS, Member, Provider and CPT codes.

Reviews the new and custom fee schedules to verify that CPT codes, rates and percentages are loaded correctly

Audit claims that follow CMS and AHCCCS rules and regulations

EDUCATION

Education High school diploma Hazelwood West High School

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