Data entry, attention to detail, team leader, subject matter expert

S. DENISE CARNELL

Lithonia, GA **************@*******.*** 703-***-****

OBJECTIVE

To secure a career opportunity where I can fully utilize my training and skills, while making a significant contribution to the success of the company

SKILLS & ABILITIES

Problem Solving

Decision Making

Organization

Teamwork Skills

Interpersonal Skills

Collaboration

Attention to Detail

Communication

QNXT 5.8

Excel

PowerPoint

Six Sigma Yellow Belt

EXPERIENCE

SR CLAIM BENEFIT SPECIALIST, AETNA A CVS COMPANY

08/2011 – PRESENT

·Analyze and approve claims that cannot be auto adjudicated

·Apply medical necessity guidelines, determine coverage, complete eligibility verification.

·Process complex claims and applying appropriate claim codes

·Identifying system discrepancies regarding provider contracts

·Ensure strict compliance with HIPAA and company standards

·Submit recommendations for improvement which led to an increase in analyst accuracy

·Work with internal partners to resolve difficult and escalated claim issues via Health Plan email and call tracking requests

·Maintained and exceed quality and production metrics consistently

·Reduced call tracking from over 90-day to under 30-day TAT

·Answer questions for new claim analyst and supervisors regarding claim processing procedures

·Train claims team on updates and clarification of processes

·Research and respond to corporate audits for the claims team

·Subject matter expert for the team answering all claim related questions for the team

COLLECTIONS ACCOUNT MANAGER, SIMMS ASSOCIATES

06/2009 – 08/2011

·Handle calls through ACD Line

·Fielded escalated calls from team members and resolved with minimal issues

·Coached colleagues on issues or questions to streamline processes and provide clarification

·Resolved billing errors and discrepancies

EDUCATION

COMPUTER COMMUNICATIONS INSTITUTE, WILMINGTON, DE

AA IN BUSINESS ADMINISTRATION

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