Stacey Marie Caver

*** ****** ******, ******, **. 35244 ● Contact 205-***-****

adytjm@r.postjobfree.com

OBJECTIVE

Independently motivated professional with background in management, manufacturing, sales, and insurance with proven leadership, communication skills seeking to secure a challenging position in a reputable organization to expand my learning, knowledge, and skills.

Blue Cross Blue Shield of Alabama

Claims Research Associate 05/08/2023

Research and process patient medical claims and inquiries.

Process claims according to business regulations, internal standards, and processing guidelines.

Resolve inquiries within accuracy and timeliness goals and specific to customer contract agreements.

Review claims for errors and compare member benefits to services requested.

Perform an analysis of the claim and make necessary updates that may include recalculation of benefits for previously processed claims to determine the correct order of benefits for payment to be made by the applicable plan.

Reject, redirect misrouted, or ask clarifying questions when information is incomplete or inaccurate to ensure timely processing.

Responsible for communicating via inquiry, email, and telecommunication across multiple areas of the company to ensure customer resolution is complete.

Proficient in inpatient and/or outpatient diagnosis and procedure coding guidelines

Knowledgeable of facility EMR, encoder, CDI tool and other support software.

• Intermediate understanding of Explanation of Benefits form (EOB)

• Understanding of ICD-10, HCPCS/CPT coding, and medical terminology.

Conifer Health Solutions

Representative Patient Access II 01/16/2023-05/19/2023

Greeted customers following Conifer Standards of Care.

Completed patient registration at date of service,

Adhered to financial and cash control policies and procedures.

Thoroughly explained and secured hospital and patient legal forms.

Scanned protected health information, created, and filed patient information packets/folders for upcoming hospital services.

Assisted with scheduling diagnostic procedures (entered data in scheduling system, provide customer with appointment instructions, and other tasks as needed},

Educated patients about patient financial liabilities, employs proper, compliant patient liability collection techniques before, during and after date of service.

Performed hospital cash reconciliation and secured payment entry in adherence to financial and cash control policies and procedures.

Secured medical necessity checks/verification in accordance to center for Medicare and Medicaid services, verifies insurance, benefits, coverage, and eligibility.

Completed assigned registration financial clearance work lists activities, obtained insurance authorization for scheduled and unscheduled hospital services, and secure inpatient visit notification to payors.

Motherson Vance, AL.-11/2018-08/2021

Team Leader

Assigned tasks and ensured high productivity levels of all team members by assisting in solving day to day problems and implementing the policies and procedures of the company.

Conducted pre-shift inspections of the assemble lines/machinery, team members training log, and planned for audits of team members procedures.

Monitored and delivered constructive criticism as needed.

Attended classes to develop effective leadership skills and training of all machinery and equipment.

Maintained a clean and safe workplace in accordance with 5s protocol.

Conducted quarterly performance reviews of team members to enhance team performance, and cross trained to maximize flexibility.

Collaborated with management and other team leads to create a safe and supportive environment.

Liberty National Insurance Company Birmingham, AL. - 02/2012-09/2018

Globe Coordinator I

Preformed telephone verification interviews to assure accurate application information.

Took customer calls and provided accurate and satisfactory answers to their inquiries and concerns.

De-escalated situations involving dissatisfied customers using patience and supportive assistance.

Called clients and customers to inform them about the company’s new products, services, and policies.

Guided callers though troubleshooting, navigating the company site, or using the products or services.

Reviewed customers or client accounts, providing updates and information about billing, shipping, warranties, and other account items.

Collaborated with other call center professionals to improve customer service.

Helped train new employees and inform them about the company’s customer management policies.

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