Hardworking, Fast-Learning Administrative Professional

Candace Taylor

Birmingham, AL ***** *******.*.******@*****.***(205) 643 2326

To obtain a position with a business that can use a hard-working resourceful individual with experience in various areas, and the ambition to learn more to become an asset to the company. I'm a fast learner and always willing to accept a challenge and learn new things while also supporting and maintaining the business objectives of the employer, and position to ensure great productivity.

Work Experience

Senior Acct Receivable Clerk (Remote)

Optum/United Health Care (Remote Position)

Jan 2023 – Jan 2025

Worked Daily reports to help ensure proper Provider Payout

Documented all internal and external inquiries concerning patient accounts including patient and third-party payers.

Acted as the first line of support to patients or third-party payers contacting the facility with questions concerning an account or claim.

Documented all actions and communication done on patient’s accounts.

Escalated problem accounts to management team for assistance and resolution if needed.

Communicated clearly resolution of issues to responsible parties on accounts.

Responded within 48 hours to patient inquiries that required research and provided updates on the status or resolution of their issue at each step of the process.

Worked with facility and internal departments to investigate and resolve issues associated with patient or insurance company inquiries.

Medicare Provider Enrollment Analyst (TEMP REMOTE POSITION)

Broad Path /Noridian Health

Dec 2021 to Jan 2023

Researched and processed incoming 855 applications to revalidate providers enrolled to provide Medicare

Entered data into internal document management and workflow systems

Performed quality check on the provider enrollment data and entered application information into claims processing systems

Create and mail notification letters to providers to inform of App Status.

Performed other enrollment functions such as status calls, basic data entry

Review, research and process provider enrollment applications abiding by contract regulations, internal policies, and guidelines

Initiate requests for information to complete the online enrollment process via PECOS and by calling outbound to provider contact to advise if information needed.

Verified credentialing information and completes fraud detection and prevention

Virtual Claims Processor/ Inquiry Analyst (Remote)

Blue Cross Blue Shield of Alabama - Birmingham, AL

May 2017 to October 2021

Provided efficient, timely and courteous service to subscribers, providers, of various BCBS Health Insurance Plans, Host/Home plans Medicaid/Medicare, PEE HIP or internal customers on claims and inquiries received.

Ensured Compliance of Deadlines and all claims processing goals specified for this position by Processing of all facility, professional, drug and dental claims and adjustments within the time frame.

Researched claims for correct ICD 9 ICD 10 coding to ensure benefits were applying correctly.

Solved complex business/customer related problems by Analysing information and performing extensive research within multiple systems and reviewing contract benefits to

Made independent decisions base on research

Ensured correctly and timely processing by using Customer Service skills when needing to retrieve info from provider by making outbound calls to office or provider contact person.

Home Customer Service Agent (PT POSITION)

Ver-A-Fast Corporation - Birmingham, AL

March 2017 to September 2021

Work from home in virtual call center making outbound or inbound calls, utilizing a web-based predictive dialing system

Maintain and deliver company protocol for variety of clients including newspapers, energy companies, blood donation centers, charities, etc

Manage time & multi-task daily doing task such as cold calling, surveys, lead generation, appointment setting, customer service follow up, verification calls, business to business calls and more

Handled emails, inbound calls, and outbound calls

Resolved customer issues

Medicaid/Medicare Provider Enrollment Analyst (TEMP CONTRACT POSITION)

Blue Cross Blue Shield/ Cahaba GBA - Birmingham, AL

February 2015 to April 2017

Enroll providers and suppliers into the Medicare program and examine and evaluate their 855-applications for completeness and accuracy.

Manage, maintain, and ensure compliance based on the CMS guidelines.

Contact providers or chosen representative to request any additional information either by fax, written, or telephone communication.

Compile written correspondence advising provider or organization of the determination of their application submission.

Identified and resolved numerous Medicare enrollment issues, resulting in more providers being added.

Education

Associate of Science

Lawson State Community College - Bessemer, AL May 2011

Advance Academics Diploma in Academics

Ramsay Alternative High School - Birmingham, AL

May 2006

Skills

•Data Entry (10+ years)

•Customer service (10+ years)

•Outbound & Inbound Calling (10 years)

•Call Center (6 Years)

•Payment processing (5 years)

•Medical Records (7 years)

•Medical Terminology (9 years)

•CPT Coding

•Medical Billing

•10 Key Data Entry

•Insurance Verification

•Microsoft Outlook

•Microsoft Office

Additional Information

•Self-motivated, independent, and willing to perform multiple and cross-functional tasks in a timely manner

•Ability to communicate effectively orally and written

•Great Time management skills and able to organize and prioritize task

•Knowledge of Microsoft Office. Ten key calculator skills, planning skills, organizational skills, communication skills, and problem solving skills.

• Knowledge of Medical, and Dental Terminology

•Ability to make sound decisions using independent judgement

•Typing Speed: 70 W.P.M and 10-Key Speed: 12,000 K.S.H

Contact this candidate