Support Specialist Pricing Coordinator

OBJECTIVE

To obtain a career that offers challenges that will enhance professionalism, provide clear career direction and promote recognition of advancement.

EXPERIENCE

****-******* ******* *dministrators Inc. Columbia, SC 29223

Pricing Coordinator/Group Support Specialist

Work deferrals on BCBSSC system, apply discounts to UB92’s (hospitals) and HCFA 1500’s (physicians) bills and per diems

Process refunds, make adjustments in RIMS system, update refund database

Work eligibility deferral list

Process drug vendor payments, percentage of savings payments and CHC payments

Process short term disability documents and payments

Correspond with groups on new and on going disabilities

Assist with Claims Exchange, Medcost, PHCS, Beechstreet pricing

2001- 2004 Planned Administrators Inc. Columbia, SC 29223

Team Leader/Support Operations

Responsible for ensuring claims are signed out to Cottage and In house keyers

Process and supervise incoming claims for sorting and look ups

Responsible for training 5-7 support operations associates on entering claims first pass

Ensure all correspondence is documented and directed to the correct file/area Responsible for making sure all claims are mailed or faxed to the proper pricing network (internal and external vendors)

1999-2000Planned Administrators Inc. Columbia, SC 29223

Support Services

Ensure claims are separated into bundles according to the network they are being routed to

Maintain PPO Journal where all claims are logged out and sent to the correct pricing network and logged in upon receipt of repricing

Open all mail received and sort all hard copy claims into proper batches

Verify patient eligibility and make necessary corrections to prepare for proper claims processing

Check PCRI to verify provider eligibility, forward documents to Provider Maintenance for updating

Maintain correct turnaround time on all claims, hardcopy and electronic

EDUCATION

1989-1992 LOWER RICHLAND HIGH SCHOOL

Diploma

2006-2008 SOUTHERN WESLEYAN UNIVERSITY

Associate of Science in Business Administration

2008-2011 Bachelor of Science in Business Administration

References available upon request

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