Benefits Specialist Data Analyst
Resume:
DATA SCIENCE PROJECTS
Aspiring Data Analyst with training and expertise in all aspects of collecting, translating, visualizing, and drawing insights from complex sets of data to help solve organizational problems and challenges.
*********@*****.***
EDUCATION
CONTACT
Google Certified IT Support Specialist 2019
Amazon Web Services In process
Certification
SKILLS
Associate of Arts Criminal Justice
University Texas Arlington 1989
Wesleyan College
Certified Data Scientist 2022
ENTITY Academy x Woz U
Magna Cum Laude
Directors List April and July 2022
Content, Email and Inbound 2020
Marketing
HubSpot Academy
Github.com/navymama/Team-Phoenix
linkedin.com/in/SonyaPMartin
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Senior Benefits Specialist 2014 to Present
Aetna/CVS/Meritain
Applies medical necessity guidelines applying precertification or medical review numbers for processing. Sending to specialized department if more intense review is needed.
Determine coverage determining that member and all eligible dependents are listed as active or have termination dates if no longer active.
Complete eligibility verification by ensuring correct plan and group numbers and level of coverage is listed correctly.
Identify discrepancies by verifying if billed codes are correct for age gender and listed diagnosis and if listed CPT codes are appropriate.
Apply all cost containment measures to assist in adjudication process.
I have experience with Medicare, Medicaid, self- funded group, and commercial groups.
Maintained 100+ claims per day metric and quality metric of 99% and accuracy metric of 95% or greater per month for eight years.
Made process improvement on claim notifications resulting in a reduction of payment errors made during processing.
Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
Sr. Benefits Specialist/Team Lead
2012 to 2021
Jacobson Solutions
Processed and adjusted medical claims for New York, Pennsylvania and other states Medicaid claims using Facets 4.71-5.0 Checked eligibility status, provider status, reviewed fee schedules and made manual pricing corrections as needed. Reviewed for correct authorization status. Worked onsite and remotely.
Pricing claims on facets, applying Centers for Medicare and Medicaid processing guidelines in addition to other physician and facility rates to Veteran Administration claims.
Responsible for team of 15+ to include attendance, progress reports and coaching, spotting trends.
Trained new hires in processes/navigation
Advised on network/internet issues and able to offer solutions, including writing training guides/processes.
Assisted in set up of VoIP equipment via chat/phone.
WORK EXPERIENCE
Machine Learning
Advanced Analytics
Natural Language Processing
Statistics and Probability
Data Visualization
Microsoft Office Suite
Python, R, SQL, NOSQL
MongoDB
Tableau
Healthcare
Product Marketing
System Administration
Hardware
Agile Project and Team Management
JIRA, Trello, Git
Grapevine, TX
ENTITY Final Project: Used Python and R to analyze drunk driving, distracted driving in relation to fatalities and created visualizations in Tableau.
Texas Road Safety Project: Clean, wrangled, and explored 2013 Texas Crash Data using Python; created visualizations to showcase trends using Tableau.
Entity Wants to Know: Suggested new program featuring Entity and Woz U instructors for short bios featured in upcoming newsletters and marketing materials.
Contact this candidate