Services Coordinator Claims Processor
Resume:
Kathryn E. Booker
Harrisburg, PA 17112
Objective
To obtain a career position that can provide an opportunity for advancement.
Experience
Appeals and Grievances Coordinator I at PA Health and Wellness
Appeals and Grievance Coordinator at Capital BlueCross
Administrative Services Coordinator at Highmark, Inc.
Claims Processor at Highmark, Inc.
Independent counselor with the YMCA childcare programs
Direct contact with customers at Arooga's Restaurant
Direct contact and trainer of new staff at Giotti's Restaurant
Work History
January 2021- Current
Appeals and Grievances coordinator I – PA Health and Wellness
Responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies. Coordinate, facilitate, and conduct managerial level conferences with customers and their authorized representatives to gather and relay information. The outcome and resolution of all appeals, grievances, complaints, and inquiries is communicated via written correspondence to the customer using clear and simple language and include elements that satisfy corporate, regulatory, and accreditation time frames, accuracy, and response guidelines.
November 2018 – February 2020 – Capital BlueCross
Appeals and Grievance Coordinator
Coordinate the internal appeals and grievances process by supporting requests in a timely manner. Support member and provider experience. Oversee and coordinate all Appeal and Grievance activities ensuring response deadlines are met in accordance with applicable best practice, state and federal guidelines. Draft and provide acknowledgements by applicable method, to inquiries, grievances and appeals as required by regulations, policy and department process standards. Prepare and provide response and resolution by applicable method to inquiries, grievances and appeals as required by regulations, policy and department process standards. Meet department and company performance and attendance expectations. Follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Maintain accurate records, including work measurement and time and attendance.
July 2012 – November 2018 – Highmark, Inc.
Administrative Services Coordinator
Corporate responsibility for answering all incoming calls for Highmark, Inc. and transferring accordingly. Manage requests for corporate meeting rooms and ensure availability of room and all requested needs are met for customers within Highmark.
Claims Processor
Review processed claims and inquiries that suspended for additional processing. Determine appropriate corrective action using enrollment, benefit and historical claim processing information. Meet production and quality standards. Elevate issues to next level of supervision, as appropriate. Maintain accurate records, including work measurement and time and attendance.
Associate Claims Processor
Determine if claim information is complete and correct. Enter/verify claims data. Resolve claim edits, review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination. Meet production and quality standards. Elevate issues to next level of supervision, as appropriate. Maintain accurate records, including work measurement and time and attendance.
October 2010-July 2012 – Metro Bank
Teller/Customer Service Representative
Performed day to day account issues, and performed customer service duties for all customers including priority customers.
May 2008 - July 2012 – Arooga’s
Server and Bartender at Arooga's Restaurant on Rt. 39
September 2005 -May 2008 – Giotti’s Restaurant
Greeted and served customers. Assisted restaurant owner with the startup of a full service restaurant. Trained new staff on server duties and using the new computer system for orders and payments.
August 2004 – August 2005 – YMCA
Camp Counselor/Latch Key Counselor with the YMCA. Worked with a team of counselors at Lawnton Elementary school supervising 40-50 elementary school students. Coordinated summer activities and after school care.
Education
2001 – 2005 Central Dauphin High School
College Preparatory
2005 – 2006 Central Penn College
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