Data Entry Benefit Specialist
Resume:
Roslyn, PA *****
Phone (***) 913 - 1253
E-mail: ********@*******.***
Leslie A Young
Work Experience
**** – Present Giant Store Employment Associate (Hiring Manager))
Performs analyses all incoming employment applicants. Responsible for making outreach calls to schedule interviews for prospective new team members. Conduct interviews to assess new potential employees for all departments. Schedule and conduct orientation session for new hires. Review and have all necessary documents signed for new hires.
Work Experience
2015 – Present Aetna Inc. Consultant/Subrogation
Performs analyses and reporting, including forecasting and trending, of financial and management information with significant financial impact for Premiums/Fees, Accounts Receivable, Overpayment Recoveries and/or Claim related activity for all products and segments. Fosters and supports collaboration across organizations and builds strong and effective work relationships; works with internal and external constituents and business owners by providing subject matter expertise to resolve reconciliation discrepancies, implements process improvements and enhanced workflows. Provides subject matter expert (SME) consultation and advice in some functional areas of responsibility, providing recommendations on workflows, policies, components of systems and in daily operations and products.
Work Experience
2006 – 2015 Aetna Inc. Senior Analyst/Medical Economics
Researching, developing and refining overpayment recovery projects referred from multiple sources. Identify leads, evaluate and analyze data to validate the overpayment of medical claims expenses. Review and interpret complex provider contracts to identify trends of provider billing practices. Retrieve reports utilizing various system applications (i.e., Microsoft access, Crystal reports and SQL queries). Ensure data quality, consistency and auditing of all reports. Provide in depth analysis of root cause and business implications. Evaluate available software applications and recommend enhancements to deliver recovery projects more efficiently.
Work Experience
2004 – 2006 Aetna Inc. Senior Analyst/Recovery
To aggressively pursue the recovery of overpaid dollars, produce actionable quality trending data and provide exceptional service to our providers and customers. Review, collect and resolve conflicting, missing or inaccurate information via telephone or written correspondence. Develop and administer overpayment recovery policy and procedures, telephone and written correspondence to members, providers and other insurers, which includes development of system reports.
Work Experience
2001 – 2004 Aetna Inc. Senior Analyst/Network Consultant
Maintains the Provider Data (demographic and contractual) for all network and non-network providers. Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings). Develops and maintains standards for database integrity, corrective actions database alignment, and manages communication processes with other departments regarding database improvements. Review of all incoming contracts for entry into HMO system. Maintain all contractual intent for correct system load. Participate on BIR calls for new or renewal of provider contracts. Coordinate with Network to ensure proper contract intent for accurate claim payments.
Work Experience
1999 – 2001 Aetna Inc. Claims Benefit Specialist
Daily functions included reviewing incoming HMO claims to determine authorized benefits and process accordingly. Also responsible for review and research for claims in rework due to incorrect payments.
Work Experience
1997 - 1999 Aetna Inc. IKFI Data Entry
To review incoming claims in imaging and key all imperative information for claims processors to pay claims correctly. Was able to maintain production 12,000 key- strokes with 99 percent accuracy.
Objective
To obtain a position in a thriving organization that will grant me the opportunity for continuous growth.
References
Available upon request.
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