PATRICIA A. BENNETT

**** *. ****** **.

Detroit, Michigan 48217

313-***-****

Email: ad2sgk@r.postjobfree.com

Professional Experience:

April 1990 – September 2022 BlueCross BlueShield of Michigan - Detroit, MI 2010 – Current Quality Performance Analyst

Responsible for maintaining and updating departmental employee’s quality records with minimum assistance or direction. Conducts individual daily audits of the quality of employee work performance and measures, analyzes, evaluates, and reports the results of the audits to the supervisor. Also assist and supports in training of departmental employees. 2003 – 2010 Group Review Analyst

Review and approve/ reject all group wide changes, group mergers and cancellation mergers. Review and administer coverage compatibility for groups in all rating classifications based on corporate underwriting policy and procedures. Determine/ review all required documents for accuracy and completion. Review and determine matrix key assignment based on information provided from marketing. Develop new matrix keys per requested customer benefits when applicable.

2002 - 2003 Group Wide Change Processor II

Processing transactions to initiate groupwide coverage changes: involving retroactive effective dates, mergers, group transfers and suffixes splits, including decision-making. Interfaces with Underwriting, Sales Support, Group Billing, Production Support, Direct Billing and Automated Billing Reporting Departments on rating/billing issues. Processing group reinstatements with/without a lapse in coverage. Respond to telephone inquiries from all areas within the corporation, internal and external stakeholders regarding the status of group changes processing. Processing the group to completion, which includes establishing Group Headers, Enrofile, BDF, NB&I, MCS (member records), Futures, Creates and Initial Billing Cycle.

1998 – 2002 New Business Group Processor I

Processing new business groups establishing group headers, process membership and initial bill processing. Responding to telephone inquiries from internal and external areas regarding the status of the group processing. Working knowledge of all transactions required to complete any group’s data.

1997 – 1998 Pricer 4 BlueCard Claims Department

Review, analyzes, verifies, and processes for approval/denial professional BlueCard Program (ITS). Turn around documents and claims. Make benefit determinations based on information contained on the claim, processing manuals and system files. Adjudicate claims within quality/ quantity criteria. Identifies and finalizes aged claims in a first in first out order. Identify system/programming problems and benefit administration inconsistencies. Interfaces with other departments to expedite claims. Utilizes specific system coding in conjunction with policies and procedures. Process inquiries from providers, subscribers, customer servicing areas and internal status inquiries.

1996 – 1997 Clerk Ford Salary Service Center

Open and close cases in the ICSI (inquiry system), sort/date stamp incoming mail and reroute all misrouted mail to appropriate departments. Deliver mail toother departments and pick-up mail daily. Xeroxing upon request and filing all completed cases daily.

1995 – 1996 Field Specialist

Provide support for the facility (hospitals) and professional providers

(physicians). Respond to telephone inquiries regarding problems with claims from providers. Research and provide answers to benefit questions. Interface with benefit and medical policy administration departments to resolve provider claim issues. Attend meetings, field training sessions, and provide direct support to the Field Service Representative. Developed documentation discovered from special projects assigned. 1991 – 1995 Pricer 7 Professional Service Claims Department Direct data-entry of claims, medical terminology, coding all types of services, adjustments, status inquiries, complimentary claims (Medicare), transmittals, applying valid deductibles/copays. Processing all types of claims and applying applicable claims policies/procedures. Completely trained to handle all types of claims processing.

1991 – 1991 Pricer 3 Professional Service

Claims Department Out-of-state section, processing simple claims e.g., office visits and labs. Preparing UCR’s (request to other BCBS plans in other states for their allowed fees) for specific procedure codes on services rendered. Handle routine write-off edits the system rejected, reviewing and determine payment or denial.

1990 – 1991 Clerk Professional Service Claims Department Open, sort, and date stamp all incoming mail. Reroute all misrouted mail to appropriate departments. Xeroxing, filing, errands and assisting with any clerical functions required. Recording accurate counts of all incoming claims

(inventory).

Education:

April 2006 – 2008

Baker College: (on-site classes at BCBSM) Coursework in preparation for a bachelor’s degree in business management.

September 1988–June 1989

Wayne County Community College, (Detroit, Michigan) Coursework in preparation for a degree in Business Management.

September 1986 – April 1987

Ferndale Medical Careers

(Ferndale, Michigan) Graduated as a Certified Medical Assistant. References Provided Upon Request

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