JESSICA ANN GOODWIN

Rossville, GA *****

423-***-**** - adwl45@r.postjobfree.com

PROFESSIONAL SUMMARY

Proactive, highly skilled administration professional with eight years of hands-on experience with diverse office environments in multiple lines of business in the Medical Insurance Field. Documented success in using various imaging tools, MS Word, Excel, Facets, Outlook, Burgess, ClaimsAdmin and BlueSquared. Very experienced when working with Employer groups, Individual policies, Prior Authorizations, CMS.gov and Evicore access - specifically with BCBST and FMCP for PIO Bluecard Home claims. Well versed in processing self and anthem initiated Adjustments. Branched out with a year of loading UM cases into Facets/V3 to to assist Facets automation.

SKILLS

BlueSquared — 5 years

AMCP, Anthem Case Management — 2

years

Facets/Proclaim/V3 — 8 years

CMS.gov — 5 years

Filenet — 2 years

ClaimsAdmin — 5 years experience

WORK HISTORY

06/2021 to Current Tier 3 Medical Claims Examiner, Research Analyst, Family Medical Care Plan – Rossville, Georgia

Process medical claims for the Provider Interplan Operations department, originally working as Temp to Hire position with eligibility issues, interpreting benefit summary, duplicate corrected split claims, tiered benefits, home infusion therapy, interpreting facets and V3, relaying that information to BlueSquared when necessary

Verified patient insurance coverage and benefits for medical claims. Analyzed statistical data using both modern and traditional methods. Keep records of claim interaction, as well as maintaining my own signoff time and schedule adherence.

Trained in Tier 1, 2, and 3 claims such as Coordination of Benefits, Lesser of Logic, Medicare, DME, Medicaid, Behavioral Health, Out of Network and Member Submitted claims

Answering Plan2Plan inquiries, general Inquiries and Anthem adjustment requests in BlueSquared

Processing Customer Service Request adjustments for PIO HOME claims Processing Anthem initiated Claim Adjustment requests in BlueSquared Loading automation failed Prior-authorizations requests from the UMdatabase, ACMP into Facets/V3

12/2017 to 12/2019 Claims Associate/Examiner

Blue Cross Blue Shield of Tennessee

Process medical claims for the Provider Interplan Operations department, originally working at the trainee level with eligibility issues, interpreting benefit summary, duplicate/corrected/split claims, tiered benefits, home infusion therapy, interpreting facets and relaying that information to claims inquiry when necessary Keep records of claim interaction/mentor inquiry, as well as maintaining my own signoff time and schedule adherence

Promoted to Claims Associate, completing additional modules in HRA Claims, Maximum Payments,

Partial PAC reductions, Medical equipment, Behavioral Health, and Out of network Claims

Additional Competencies include: Bluecare claims including direct paid claims Worked reports as they were released, finished online courses as workload allowed 07/2017 to 12/2017 Senior Care MedAdv Enrollment Specialist Office Team, BCBST

Blue Cross Blue Shield of Tennessee - MedAdvantage enrollment assistance included manual data entry of member and broker provided applications for our senior care division by accessing workload through TRR Database

Worked with multiple members, correspondence and CMS.gov to assist senior care members with their future policies through our company system. 04/2016 to 06/2017 Cigna Medical Insurance, Provider Services Assisted members and providers with benefits, eligibility, claim information, prior authorization status while educating them on the process of appeals, denials and pre-determinations

Utilized additional training to assist with advanced radiology and chemotherapy benefits by accessing authorizations through evicore. 08/2014 to 03/2015 Medical Application Specialist

Wellpoint Medical/Anthem Inc

Assisted members with selecting policies in the very new Healthcare.gov application portal

Explained in detail to future members how each policy, as well as subsidy, worked Enter, update, and retrieve information from teletype networks and computerized data systems regarding the better fit plans for members and current options available to them

EDUCATION

General Education Diploma

Chattanooga State Community College - Chattanooga, TN

Contact this candidate