Data Entry Call Center
Resume:
Linda R. Josey
*****.*****@*****.***
Summary
A highly motivated, organized, and intelligent Healthcare professional, who can efficiently and accurately handle multiple tasks.
In-depth knowledge of Healthcare, disability, accounting, life insurance, revenue, reimbursements, claims, Health benefits, banking and Call Center expertise.
Sound knowledge of electronic billing systems and reporting; CPT, Lotus notes, ICD-9, ADHOC, Crystal Reports and HCPCS coding guidelines, Long-term care policies.
Excellent working independently or as a team player; dedicated, flexible, genial, and eager to learn new skills while applying old ones from within a wide range of life experiences.
Thrives on solving problems and creating innovative solutions during even the most troublesome situation.
Education
Associates Degree in Christian Ministry & Business from Ebenezer Bible College – Hartford, CT
Technical Skills
Microsoft Office: Word, Excel, PowerPoint, Access
HIPPA, ICD-9, CPT Coding, HCPCS codes, EOB,Medical Terminology, Healthcare Guidelines
HIPAA Privacy, Security Rules, Data Entry, Healthcare auditing, LTC policies
SAP, PeopleSoft, Lotus notes, Crystal Reports, Systems: Epic, Centricity, IDX, EMT, Ebridge.
Connecticut Electronic Disease Surveillance System.
Business Skills
Team-Player, Multi-tasker, Good Organizational skills, Excellent Communication skills, Great
Time management
Professional Experience
• Check Facets application if the provider
INFOSYS, Atlanta GA/Hartford, CT - Work From Home September 2021 –
Product Analyst
reviews the claim which has provider data issues and failed to select a provider automatically record exists using the data provided in the claims like NPI (National Provider Identifier), Tax ID number, Provider group information • Correct existing provider record if
Provider Data Management Analyst reviews the claim which has provider data issues and failed to select a provider automatically.
Check Facets application if the provider record exists using the data provided in the claims like NPI (National Provider Identifier), Tax ID number, Provider group information
Correct existing provider record if needed to be able to process the claim
Set up new provider non-participating record through Front end facets if the provider data does not exist in the system.
Produce closing of the Providers Kart record by reviewing that the status has been provided to triage and closing by checking the NPI verses the Provider credentialing has been satisfied.
Professional Experience
OnLine Systems LLC/Department of Public Health, Hartford, CT Mar 2021 –
Data Entry Analyst I
Ensures that all customer emails and support ticket inquiries, requesting assistance or user access and account maintenance are immediately resolved.
Enter Medical Applications for positive and negative data for Covid 19 by location.
Compile, sort, file incoming faxes daily.
Assist with the documentation of processes and procedures for both individual and groups.
Perform all other duties as requested to assist in the effective operation of the overall operation.
Meridian Medical Management, Windsor, CT
Accounts Receivable Specialist October 2019 – Present
Performs follow up on outstanding physician claims as directed per the current A/R plan.
Identifies issues resulting in non-payment of claims due to internal/external issues.
Maintained scheduling meeting and updating MicroSoft calendars as well as conference calls daily.
Elevates significant issues to the Accounts Receivable Manager for further management interactions.
Works collaboratively with other operationally units to expediently resolve outstanding physician claims.
Maintains strict patient confidentiality.
Follows the General A/R and the Client Specific Guidelines.
Maintains baseline level of accounts/week.
Attention to detail with the ability to produce high quality work.
General knowledge of ICD10 diagnostic and CPT procedural coding.
Thorough knowledge of third party carriers.
Ability to identify and resolve problems.
Ability to meet department standards regarding production and quality.
Orthopedics Associates of Hartford, Farmington, CT Nov 2017 – November 2019
Accounting & Surgical Estimator
Process and send out calculated surgical estimates to patient for upcoming surgeries.
Strong customer Service between the Patient and MEA’s.
Responsibilities includes verifying insurance eligibilities for co-pays, deductibles, and co-insurance and out of pocket maximum.
Monitored, researched, and resolved collection of outstanding premiums, overdue accounts and revenue adjustments, Long-term-care (LTC) policies.
Set up payment arrangements for large patient estimates that cannot be fulfilled.
Collect payments via cash, checks and credit cards and apply to patient’s accounts.
Process current and outstanding claims accurately and proficiently and reimburse any over payments.
Act as subject matter expert in support of segment and enterprise initiatives.
Alleanza Partners, Neos, Hartford, CT May 2017 – Sept 2017
Quality Review Analyst
Effectively review and update Group life policies which includes, Short term and Long-term Disability, Accidental Death and Dismemberment policies.
Responsibilities include training of New Hires updating training policies.
Complete the required number of quality assurance audits and identify inaccuracies in customer policies.
Obtain data review and input into SAP.
Work with vendors partners to create and implement end to end data analysis, reconciliation, discrepancy resolution process for enrollment.
MCRA, Manchester, CT Mar 2017 – Apr 2017
Reimbursement Specialist
Responsible for processing claims quickly and accurately to ensure there are no errors in the claim.
Customer Service making and receiving calls about any discrepancies.
Monitors, researches, and resolves collection of outstanding premium, overdue accounts, or long term revenue adjustment issues and reports corrections or coordinates collection.
Updating patients' medical files and ensuring that other members of the medical staff are aware of the changes.
Investigating claims issues and making recommendations to management for process improvements
Complete the required number of quality assurance audits and identify inaccuracies in customer policies.
Matched up invoices with correct documentation.
Work with vendors partners to create and implement end to end data analysis, reconciliation, discrepancy resolution process for enrollment.
Travelers Insurance, Hartford, CT Oct 2014 – Aug 2016
Policy Specialist
Effective and timely handling of all incoming requests for policy information and retrieval of Commercial Lines policies endorsements and Underwriting information from various databases.
Responsibilities include the resolution of inquiries from clients, brokers and internal associates.
Assemble certified policies provide policy information to a variety of customers in support of research, claims and litigation for all Business Groups within Commercial Lines.
Reimbursement and short term disability and long term care insurance.
Provide retrieval service of policy documents in response to requests from Field and Home Office business partners, agents and insured, often within tight timeframes. Scan and review output for accuracy, legibility and completeness. Assemble policy following the Commercial Lines structure to include jackets and coverage parts to be used for litigation, claims and/or coverage determination.
Timely processing of claims, in accordance with client requirements, member plan benefits and applicable network fee schedules and regulations, LTC policies.
Cigna, Hartford, CT Aug 2014 – Oct 2014
Business Project Analyst
Work with vendors and key matrix partners to create and implement end to end data analysis, reconciliation, discrepancy resolution process for enrollment and financial data within the Healthcare segment for on and off Marketplace business.
Support daily, weekly, and monthly reconciliation efforts across multiple internal and external matrix partners and systems including researching and resolving transactional errors.
Partner with vendor partners to analyze and understand all financial and enrollment discrepancies uncovered during the monthly reconciliation process between the Healthcare Marketplace and the enrollment and billing vendor.
Communicate the status of monthly reconciliation and the disjoint resolution process to cross functional matrix partners and leadership.
Analyze, summarize and provide recommendations related to the validity of enrollment and financial data support in the Healthcare exchange user fee, cost share reduction financial impacts, and applied premium tax credit payments.
Partner with operational and information technology teams to influence and develop and implement technology and business processes that enable operational costs and support corporate or statutory audits.
Use data-based analysis to drive decreased disjoint metrics and operational efficiency.
Maxim Healthcare, Travelers Insurance, Hartford, CT Mar 2014 – Aug 2014
Data Entry Analyst II
Enters data into computer using various data entry devices. Compares data entered with source documents, or re-enters data in verification format on screen to detect errors.
Compile, sort, and verify accuracy of data to be entered re Workers Compensation benefits.
Manipulate existing data, edit current information, or proofread new entries in database for accuracy.
Utilize optical scanners along with keeping records of work completed.
Perform all other duties as requested to assist in the effective operation of the overall operation.
Provide objective written feedback in a clear, concise, and effective manner that is appropriate for the target audience.
Review and score the quality of calls and transactions.
Evaluate the work product of BPO vendors.
Triad Healthcare Musculoskeletal Inc., Plainville, CT Jan 2012 – Apr 2013
Claims Analyst
Leads evaluation and approval of appeal response letters.
Modernize data entry into multiple queues for processing. Heavy call center environment.
Investigate, analyze and resolve claims exceptions using established procedures.
Timely processing of claims, group benefits in accordance with client requirements, member plan benefits and applicable network fee schedules and regulations.
Adjudicated claims in compliance with HIPAA guidelines.
Collaborate with business partners; serving as a liaison and reference source for resolving complex claim situations.
Facilitate follow up approvals of unpaid claims with the insured to analyze and validate payments for use in billing.
Assist in research, development and resolution of specialized projects as requested by senior leaders.
Manage dedicated relationships with internal and offsite teams to safeguard client information, ensure quality of work and integrity of proprietary data. Demonstrative ability to meet established deadlines.
Coordinating the integration of clinical and financial data.
Actions legal compliance by following guidelines, account contract, and the company's business plan.
Maintains quality service by following corporate provider and payer service practices and protocols.
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