Relations Specialist Claims
Resume:
Shirley Berry-Benton
*******.*******@*****.***
HIGHLIGHTS OF SKILLS and QUALIFICATIONS
HIPAA/ERISA-compliant health insurance benefits specialist. Excellent written
and verbal communication skills. Resourceful problem -solver with excellent organizational and prioritizing skills. Strong and effective time management and
decision - making skills. Professionally courteous and diplomatic customer- relations specialist.
Extensive knowledge of Managed Care (HMO, POS, EPO, PPO) health plan
administration. Working knowledge of ICD -9 and CPT coding and Medical
Terminology. Microsoft Word, EXCEL, ACCESS, Quicken, Word Perfect software experience
PROFESSIONAL EXPERIENCES
PERSONAL CAREGIVER- 2008- 2020.
* Provided personal home care for a terminally ill cancer patient, transport
patient to and from chemotherapy at Atlanta cancer care
* Administered medicine/ Neulasta IM for the patient to maintain a normal white
blood cell count as possible
* Observed patient for any side effects and or adverse reactions to drug such
as nausea and vomiting, blood pressure.
* Performed Venous punctures for lab work, label and deliver to Cancer care Laboratory
For two and a half years
BLUE CROSS AND BLUE SHIELD OF GEORGIA - UTILIZATION MANAGEMENT REPRESENTATIVE II - 2003 to current 2008
* Received, managed and resolved all inbound telephone queue calls,
initiating the prior authorization/pre-certification process by obtaining
information to determine member eligibility, provider participation status and
benefits coverage, entering the information in the utilization management system,
prior to referring all clinical calls to medical review staff.
* Accurately documented information using appropriate documentation
standards.
* Performed data entry of medical referral cases and approval status for
procedures not requiring clinical review, assigning ICD-9, CPT, DRG and service
categories, consistently adhering to HIPAA and ERISA regulations and corporate
policy/procedural guidelines.
BLUE CROSS AND BLUE SHIELD OF GEORGIA - CLAIMS SPECIALIST III - 2001- 2003
* Adjudication of group HMO, POS, and PPO medical claims, in accordance with
multiple provider reimbursement agreements, AMA coding guidelines, HIPAA and
ERISA regulations, and various group policy guidelines.
EDUCATION
Georgia Perimeter College - Clarkston, Georgia
A.A. Degree DeKalb College
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