Entry Agent Data
Resume:
Anita McCullough
OBJECTIVES
To secure employment with a reputable company, where I can utilize my skills and business studies background to the maximum. Seeking a challenging career in the Customer Service and Healthcare Industry.
Professional Summary
Experienced professional with over 10 years managing day to day tasks, special projects, Training, direct and indirect supervision, monitoring, mentoring and administration. Exceptional ability to work through business challenges to develop solutions for everyday problems, client services and problem resolution with extensive knowledge of Medicare, Medicaid and supplemental benefits, policies and procedures. Trained and licensed as a Certified Clinical Medical Assistant. Recently trained and certified as a Benefits Specialist. A strong analytical ability, with fluent oral and written communication skills, a desire to help people solve problems and resolve issues.
Cigna Health
2023
Intake Care Senior Representative
Responsible for supporting the
Precertification Nurse, Medical Director and Director of Health Services by collecting, interpreting and evaluating medical information received for authorization. Communicate with internal and external providers. Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal. Review authorization requests and make determinations on the correct authorization process.
Kern Health Systems
2022
Non Clinical Intake Coordinator III Certified
Bakersfield, CA
Verified Health Insurance, Utilized various Medical Health Insurance systems and Processed Medi-Cal Authorization Review Referrals
CVS CareMark
2020 - 2022
Health Intake Data Entry Agent
Remote, Sandy Springs, GA
Processed Medicaid Prior Authorizations, made New York outbound calls on pharmacy prescription determinations. Worked closely with providers to process prior authorizations and drug benefit exception requests on behalf of the Client as the client and in accordance with Medicare Part D CMS Regulations.
Chime's Solutions
2020
Enrollment Benefits Specialist
Remote, Morrow, GA
Processed and answered Supplemental and employee Health Insurance Enrollment inquiries.
Externship at One Stop Medical Institute
2020
Clinical Medical Assistant
Douglasville, GA
Coordinate patient scheduling, facilitate office visits and manage patient records, including Electronic Health Records (EHR), assist with exams, administered injections, phlebotomy, and laboratory procedures, collect and post payments.
Personal Caretaker
2018 - 2019
Savannah, GA / Douglasville GA
Provided transportation to medical appointments, Daycare, grocery stores, pharmacies, completed documentation and other tasks as needed.
Blue Cross and Blue Shield of Kansas/Staffing Agency
2018
Customer Experience Representative
Tucson, AZ
I performed the tasks of a Customer Experience Representative for Blue Cross and Blue Shield of Kansas, Medicare Supplemental Insurance Plan 65.
I answered telephone inquiries from Providers and Beneficiaries, updated files, accepted premium payments, made reinstatement decisions, generated EOB’s, submitted and resolved complex inquiries.
Cahaba GBA, LLC.
1997 - 2018
Medicare Senior Service Coordinator
Savannah - Douglasville, GA
A Team Leader of 7 years to Medicare Part A and Part B Customer Service Representatives. Managing day-to-day tasks, special projects, training, supervised, monitored, mentored, reviewed and answered CMS Correspondence, performed daily time scheduling and service administration. Handled Supervisor call backs, client services, problem resolution with thorough knowledge of Medicare benefits policies and procedures. Utilized the MCS mainframe system that Medicare Part B carriers use to process Medicare Part B Claims and Part B Provider inquiries. Checked claim status, adjusted claims, reviewed Payments and check status. Researched, adjusted and provided in depth resolutions on Medicare Part A claims via the Fiscal Intermediary Standard System (FISS) Direct Data Entry (Data Entry Data) system, reviewed and researched MSP inquiries, Provider Enrollment inquiries, entered data in the Provider Enrollment, Chain, and Ownership System (PECOS) system and provided resolution for complex inquiries.
Aetna
1990 - 1997
Medicare Beneficiary Customer Service Representative
Savannah, GA
Answered Medicare Part B Beneficiary calls and inquiries, reviewed claims, verified eligibility, provided claim status, generated duplicate Medicare Summary Notices (EOBs), submitted referrals to other Inter-office departments to resolve inquiries outside of the customer service department.
EDUCATION
Cobb Medical Institute
Certified Clinical Medical Assistant
Nov. 2019 - Mar. 2020
Draughons Junior College, Savannah, GA
Associates of Science, Travel and Tourism – 1982 - 1984
SKILLS
Software/Databases: MS Office, MS Word, MS Excel, MS, CMS Only Manuals, MLN
Matters Articles, TDL’s, FISS, DDE, APEX, MAS, PEGA, Credit Balance Reporting System, MCS, HIGLAS
PECOS, SC LOGIC, Blue Pumpkin, Oracle, Practice Fusion, Jiva6, CCS, QNXT, JIVA, Outlook
CERTIFICATION
National HealthCareer Association, Phlebotomy, EKG, Billing and Coding, CPR, Job Smart Workshop
Contact this candidate