Data Entry Verification Specialist

Brenda Berrian

E: ******@*******.***

C: 813-***-****

Resume of Brenda Berrian

Professional Profile:

Over 10 years of experience in Various Healthcare settings

Strong background in credentialing, A/R, Insurance Verification, Enrollment, and Data Entry

Experience with Medicare/Medicaid

Knowledge of CMS-1500/UB92 Billing forms, aging reports, ICD-9, CPT, Medical Terminology

Strong Business Office procedures

Proficient with Avality, Cactus, MS Word, Outlook, SharePoint, Oracle, Typing 40-45 WPM, 10 key data entry

Professional Experiences:

BlackstoneMedicalServices LLC-Tampa, FL Authorizations 05/25/2022-Present

Obtain prior authorization for procedural orders by completing the authorization process with all commercial payers

Provide documentation to prove why a particular procedure was chosen, to determine if it is medically necessary and whether the procedure is covered

Imagenet LLC-Tampa, FL Enrollment 09/2021-01/2022

Ensuring that applications are completed correctly and that the required supporting materials have been provided

Entering, Updating and reviewing data and records

Processing enrollments

Assisting with billing and payment processing

OneTouchDirect LLC- Tampa, FL Customer Service 06/2021-09/2021

Provide timely, accurate, and efficient service to our customer via video chat

Verify member identification

Assist customer to troubleshoot verification issues and provide a working solution

Spectraforce Technologies-Remote Benefit Verification 10/2020-02/2021

Review all patient insurance information needed to complete the benefit verification process

Triages cases with missing information to appropriate program associate

Verify patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options

Documenting/initiating prior authorization process, claims appeals

Employment Gap Covid-19 12/2019-10/2020

WellCare -A/P Clerk Tampa, FL 07/2019-11/2019

Assist with various analyses and request from management/other departments

Communicate issues clearly and confidently with supervisors/Ensure progress

Responsible for day to day scanning of invoices, Data Entry, month end task

Respond timely and completely to requests from management and other departments

Employment Gap- Reemployment 04/2015-04/2019

WellCare- Tampa, FL Credentialing 06/2015-04/2019

Complete/submit initial credentialing/re-credentialing applications

Collect/maintain copies of current state licenses, DEA, malpractice coverage

Conduct background investigation/ensure appropriate follow up

Process NPI updates, follow up health government plans, hospitals/facilitates

Prepares credentials file for presentation to the Credentialing Committee within time periods

Provider Communication Administrative Assistant

Support Provider Communications Specialists

Monitor submissions and notified Specialists of approval or rejections

Post final approved materials on the SharePoint document library

Claims Data Analyst

Experienced analyzing claims data and researching claims

Process claims, documents, and claims correspondence

Evaluate claims to ensure compliance with established claim payment policies/procedures

Ensure claim discrepancies are resolved

Experienced analyzing claims data and researching claims

Coram/CVS Healthcare- Tampa, FL Medical Collector 03/2014-06/2015

Perform basic accounts receivable

Review zero pay to determine proper handling

Follow-up status of appeals, correct and resubmit claims to various carriers

Request medical records to resolve denied claims

Panther Medical LLC- Tampa FL, Medical Collector 01/2014-03/2014

Perform various collection actions by contacting Insurance companies/patients via phone

Review zero pay to determine proper handling

Follow-up status of appeals, correct and resubmit claims to various carriers

Request medical records to resolve denied claims

CareCentrix- Tampa FL A/R Specialist 01/2013-12/2013

Confirm/Determine refund should be given to Insurance carrier

Review invoices for duplicate payments and confirm double payments

Research patient claims to confirm a refund is due or an adjustment via ERA, Unity, Claims 98/Availity

Insurance Verification Specialist- Tampa FL

Perform Eligibility and Benefit check via Availity

Reach out to Health Plans to obtain Benefits and Authorizations

Obtained pre-authorizations

Education:

Ultimate Medical Academy- Tampa FL Medical Billing/Coding 02/2008-11/2008

Contact this candidate