Data Entry Benefits Specialist

MARK RYAN

**** ****** **. ********, ** ***** · 863-***-****

*********@*****.***

EXPERIENCE

**/**/** - *******

MEDICAL BILL REVIEWER, summit holdings, inc.

Key in medical bills into systems

Pay medical bills according to state fee schedules, PPO arrangements, negotiated settlements, etc.

Key in and pay multiple invoices including, medical, legal, mileage, etc.

Take inbound calls from providers and patients concerning bill payments

Outbound calls to providers to follow up on bill issues

10/01/2018 – 03/08/19

PATIENT SERVICES REPRESENTATIVE, welldyne Rx.

Enroll new patients into drug program

Take inbound calls from patients and fill prescription drug requests

Assist patients with enrollment of web portal

Outbound calls to patients as needed for clarification of prescription drug orders

09/01/18 – 09/25/2018

DATA ENTRY CLERK, Provest llc.

Data entry of demographic info for legal documents

Verification of account handling for documents

Upload documents to server process server handling.

04/13/1987 – 04/01/2017

SR. CLAIM BENEFITS SPECIALIST, Aetna Insurance Co.

Trained in latest HIPPA requirements

Dedicated employee for large plan sponsor

Handled Medicare and Medicaid claims and compared them to current federal requirements

Submitted claims to SIU unit for preliminary investigations based on detection of claim elements

Submitted claims to clinical analysis unit for medically necessary determinations

Reviewed medical, hospital, surgery claims for medical necessity and confirmed correct ICD10, CPT procedure coding

Sent out correspondence to providers when additional claim information was needed

Made outbound calls to providers for additional claim information

Requested and uploaded medical records into claim system for review by clinical department

Priced and processed claims with current negotiated pricing data

Performed claim projects for state specific legislative requirements and updated database with review determinations

Trained and mentored new employees starting in unit

Performed training simulations for perspective new customers

Backed up customer service unit and answered phones during peak hours. Answered claim questions from members, providers, brokers, plan sponsors legal entities, etc.

Claim Data Specialist for two years during career – pulled reports from databases and compiled data for departments for project handling. Also, performed synchronized medical file updates with outside pharmacy vendors.

Assistant Claim Supervisor for two years during career – Assisted primary claim supervisor in supervising 60 employees in a combined claim unit. Helped with yearly employee performance reviews. Reviewed daily claim reports and performed investigations into claim issues. Backed up all floor supervisors during vacations

EDUCATION

06 2020

BACHELOR’S DEGREE IN SOCIOLOGY, grand canyon university

2018 – President’s Academic List

06 1979

HIGH SCHOOL DIPLOMA, chalmette high school

Business/College emphasis

National Beta Club

SKILLS

Typing: 52 wpm

MS Office trained including Work, Excel, Access, Outlook, Publisher

Digital record experience

Detail oriented

RUMBA mainframe trained

ERISCO software experience

Micrographics experience

FACETS software trained

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