Shirley Berry-Benton

adp5ef@r.postjobfree.com

404-***-****

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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