Medical Billing Data Entry
Resume:
Cynthia Mack
Saint Albans, NY *****
*******************@*****.***
Work Experience
Database Analyst
EmblemHealth / Cognizant / HIP
March 2006 to February 2017
Responsible for maintaining CPF Provider Database support for the Northwell Health Systems.
! Tracked and executed provider file updates while ensuring timely and accurate responses to data issues.
! Created, activated, terminated and maintained providers locations via files received from other entities using
Provider Datasets; Handled special projects, including LEAN.
! Provided ongoing provider file database maintenance, modification and contract linkages for Emblem Brands.
! Conducted all processes related to provider file maintenance in accordance with established company policies.
! Provided technical support to staff members regarding all aspects of provider reimbursement.
! Coached and developed staff via one-on-one meetings to align them with objectives and monthly goals.
! Successfully resolved challenging situations with providers by initiating appropriate actions to resolve matters.
! Oversaw and ran necessary reports to ensure all statuses were worked on in a timely manner.
! Consistently adhere to HIPPA, NCQA, and AMA Guidelines.
! Ensured the highest levels of accuracy when creating and submitting provider statements on a monthly basis.
! Transferred physician contracts to appropriate CPT-4 Codes; loaded codes to QCare mainframes. Senior Data Entry Clerk
EmblemHealth / Cognizant / HIP
February 2001 to February 2006
Updated data into the computer database utilizing proficient knowledge of QCare and MSL.
! Performed data entry to create and update records; maintained both electronic and hard copy filing systems.
! Carefully reviewed all work performed to ensure accuracy and timely transmission.
! Contacted providers directly when certain claims required clarification or additional documentation.
! Checked claims, postings, and documents for correct entry, accuracy, and proper codes before submission.
! Worked closely with management to ensure company operations were in accordance with regulatory agencies.
! Provided excellent customer service when contacting providers directly to explain any discrepancies.
! Reviewed claim denials and payer requirements for corrective action and prevention in the future.
! Resolved claim issues by working with internal and external departments. Data Entry Clerk
EmblemHealth / Cognizant / HIP
December 1999 to January 2001
Compiled, sorted and verified the accuracy of data before entering into company database.
! Processed claims for HIP; Reviewed, investigated and adjudicated professional claims according to plans.
! Performed data entry to create and update records; maintained both electronic and hard copy filing systems.
! Provided excellent customer service to staff members and when speaking to providers.
! Consistently ensured efficient operation at all times and submitted timely claims, denials and/or terminations.
! Maintained strong and positive relationships with existing corporate customers and staff members. Education
Medical Insurance Billing and Coding Program
Queens College
January 2020
Skills
• Meticulous and dedicated seasoned professional seeks to obtain a full-time position within your establishment. Utilizing strong communication skills, organizational skills, and multi-tasking abilities. Able to work well independently and as part of a productive team, demonstrating reliability and strong problem-solving abilities. Possessing a stable work history of over 15 years, excellent interpersonal skills and an exceptional capability to work under pressure. Adept at interfacing with personnel and management at all levels. Accustomed to working in fast paced environments with the aptness to think quickly and successfully handle difficult situations.
• TECHNICAL SKILLS
• Proficient in Emblemhealth Software (CPF, Qcare, MCS- Corprod, E-Saws, MSL),
• Microsoft Office, Data Entry, CPT-4 Coding, Computerized Medical Billing. ICD-10 & HCPCS, E-Paces
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