SUMMARY

Data Specialist with quantifiable experience providing clerical support and completing tasks in the maintenance of databases. Extensively utilized Excel spreadsheet programs to abstract and manipulate data for daily and archival reports. Entered commands and activated controls to both operate and integrate equipment in a Windows multi-screen environment for claims processing. Analyzed, compared and re-entered data from source documents, in an auditing function. Assured compliance by securing and maintaining confidentiality of data in accordance with (HIPAA) protocols.

COMPETENCIES

10 key Data Entry

Key Account Support

Microsoft Office/Excel

Production Processing

Quality Control

Mail Room Support

TRAINING AND CERTIFICATIONS

1800 hr. Certification in Information Technology

HIPAA certified /compliant

PROFESSIONAL EXPERIENCE

Molina Healthcare, Inc., Detroit, MI

Claims Support Processor

July 2017 – Present

Analyze, review and process paper & EDI (HCFA 1500, UBO4) medical claims accurately and thoroughly according to the benefits and eligibility guidelines.

Pay, pend or void based on established claims processing criteria.

Work inbox queues daily to ensure claims issues are handled timely.

Handle incoming/outgoing written correspondence to providers to resolve discrepancies and correct edits.

Special projects as assigned.

Molina Healthcare, Inc., Troy, MI

Data Specialist / Contracted through B2B Staffing Services

October 2015 – July 2017

Reviewed documents for Health Risk Assessment information accuracy.

Researched, verified and resolved any issues in the pursuit of data integrity.

Developed and implemented a time- table matrix to ensure successful task completion.

Provided clerical support and performed tasks necessary for maintenance of various databases, including Excel.

Secured and maintained confidentiality of sensitive data, assuring compliance in accordance with (HIPAA) protocols.

Datamatics Global Services Inc., Livonia, MI

Data Specialist

October 2014 – October 2015

Entered commands and activated controls to integrate and operate equipment in a Windows multi-screen environment for vision claims processing.

Conducted research and analyzed data to ascertain proper coding for eligible provider reimbursements.

Utilized Excel spreadsheet programs to abstract and manipulate data for daily and archival reports.

Trained and supervised new hires; leading to a 23% increase in production within a 30-day period.

Analyzed program error messages and responded appropriately to correct or terminate program.

Michigan State Industries

Academic Tutor

September 2010 – July 2014

Privately instructed adult students in preparation for the G.E.D. examination.

Prepared lesson plans/learning modules for tutoring sessions according to students’ need and goals.

Taught study skills, note-taking, and test-taking strategies.

Administered and/or scored academic and diagnostic assessments.

Provided feedback employing positive reinforcement to encourage, motivate and build confidence.

Continental Life Ins. Co

Data Specialist

October 2009 – May 2010

Contractor through Headway Corporate Resources

Read source documents and entered data in specific fields using keyboards or scanners.

Researched, compiled and verified the accuracy of data prior to entering.

Compared data with source documents, and re-entered data in verification format to detect errors.

Maintained logs of activities and completed work.

Prepared and submitted task update reports.

EDUCATION

Spring Arbor University - Bachelors of Arts, Business Administration (Pending)

Glen Oaks Community College - Associate of Arts, Business Administration 4.0 GPA

Bureau of Apprenticeships & Training. - 1800 hr. Certificate in Information Technology

Claims Examiner - ad3shx@r.postjobfree.com – 615 W. Lafayette, Ste. 500 / Detroit, MI 48226 / 313-***-****.

Utilization Review Specialist - ad3shx@r.postjobfree.com – 3031 W. Grand Blvd, Ste. 460 / Detroit, MI 48202 / 866-***-**** x158374

Resource Planning Specialist - ad3shx@r.postjobfree.com – Cigna-HealthSpring

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