Stacey A Sullivan

**** ** ***** ****

Albuquerque, NM 87113

505-***-****

adyktg@r.postjobfree.com

Professional Profile: Extensive experience in medical underwriting and the healthcare industry. Exceptional work ethic, reliable and a team player. Work Experience:

Presbyterian Health Plan, Provider Network Operations - 2017-2022 Provider Network Relationship Associate

• Provide assistance with Long Term claims and EVV claims for my 4 Executives. Also provided assistance inputting provider information into the database to ensure provider claims would pay accurately.

• Accessed and was responsible for all Long Term Care claims in the HealthX claims system

• Responsible for ensuring that all Home Modification invoices were scanned and sent to the claims department for processing

• Replied to all prover emails as well as any internal emails

• Participated in our Provider Education Conference Presbyterian Health Plan, 2014-2017

Appeals and Grievance Coordinator

• Addressed member grievances within the required timeframes per compliance Presbyterian Health Plan, 2011-2014

Individual Medical Underwriter

● Apply medical terminology and underwriting tools in assigning risk to Individual Plan Applicants

● Asses if Individual Plan Applicants can be approved, rated up or declined

● Medical stop loss reporting on catastrophic claims for ASO groups

● Support large group and small group underwriting in evaluating the

health risks of groups

● Support manager on case investigations

Blue Cross Blue Shield of New Mexico, 2000-2011

Small Group Underwriting Analyst, 2002-2011

● Renew 2-150 life, key accounts

● Analyze prior carrier claims experience and assign rates

● Analyze and assess medical risk for renewals, proposals, and new groups (both small and large group)

● Ensure accuracy on all renewal and new group paperwork

● Perform all re-rating for small group renewals

● Prepare rates for small group renewals

Account Coordinator/Database Specialist, 2000-2002

● Processed paperwork for new, small groups

● Built and maintained the sales and underwriting database

● Manufactured all reports for the sales and marketing department American Property Management, 1997-2000

General Manager

● Managed all employees, payroll, scheduling, and all customer service issues

Stacey A Sullivan

6309 La Habra Lane

Albuquerque, NM 87113

505-***-****

adyktg@r.postjobfree.com

Skills:

● Experienced with Microsoft Word, Microsoft Excel, Windows, Macintosh, Q-Basic, Telemagic, Anasazi, Saleslogix, Lotus Notes, Word Perfect, Limited SQL & Microsoft Access 2007, and all internet functions

● Outstanding customer service skills and experience

● Excellent attention to detail

● Dedicated and dependable

● Positive attitude

● Business Objects Reporting

Education:

Community College of NM-1995-1997-Arts & Sciences, and Computer Programming classes.

Eldorado High School-1992-1995, High school diploma