Customer Service Data Entry

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

678-***-**** Cell Eddie *******@*****.***

EDDIE LASHAWN FORGE

Objective: To Become employed with an organization where I am offered the opportunity to demonstrate my personal diverse skills and educational knowledge

Functional summary

Excellent multi-tasked candidate who demonstrates integrity and commitment to assignment. Exhibit team player and leadership qualities. Diverse and knowledgeable in many industry levels.

Technical summary

Nextgen; Mckesson; NASCO; QCARE; EHR; EMR; AS400; COSMOS; ICRS; QCARE; AMISYS; Entrendex; GEBAR; Oracle; Guide applications; Microsoft applications; CBIT; Quality Rating System (QRS); CPT 4 Coding; ICD 9 Coding; HCPCS Coding

Employment

08/11- Present Naphcare Birmingham, AL

Claims Adjudicator/Data Entry Clerk

Provide efficient, timely, and courteous service to customer regarding

inquiries received on UB, HCFA1500, Dental and/or Pharmacy.

Telephone Development of claims.

Investigate all inquiries concerning contract benefits.

Answering questions from Customer Service, Management while

maintaining a daily workload.

Excellent data entry of claims for processing.

Provide Front Desk Coverage.

Provide Check Run Duties.

Any other duties assigned.

03/11- Present ITAC Solutions Birmingham, AL

Clerical Specialist

Provide service to multiple companies through clerical duties.

Any other duties assigned.

09/07 – 03/11 Aristoi, Inc Birmingham, AL

Notification Coordinator

Accounts Receivable Representative

Provide insurance follow-up regarding hospital and medical claims

Collect high dollar amounts on aged accounts

Contact carriers for insurance verification

01/01-08/07 United Healthcare Birmingham, AL

Notification Coordinator

Responded to incoming notification calls within the phone processing benchmark.

Utilized Care coordination tools for processing notification calls to providers, multiple insurance companies, etc.

Communicated accurate and appropriate information to providers and members regarding eligibility and coverage.

Entered required notification data and other documentation within established benchmarks for accuracy and timeliness.

Communicated expected length of stay for inpatient cases in accordance with program policies.

12/97-11/00 Blue Cross Blue Shield Birmingham, AL

Claims Analyst

Verify, review and update medical (hospital, physician) claims

including diverse policies to determine eligible reimbursement.

Reconciled claims adjusters’ estimates.

Negotiated payment to all parties to include necessary follow-up to

ensure appropriate payments.

08/90-11/97 Health Partners Birmingham, AL

COB Analyst

Coordinated and researched other insurance benefits.

Processed Coordination of Benefits, Worker’s Compensation, Subrogation and pharmacy claims via production environment.

Accurately interprets and understand diverse contracts.

Exceed established quality and production standards.

Adhere to and interpret company policies and federal regulations.

Ability to understand appropriate claims processes and course of

action in adjudication.

Receive all coordination of benefits information to process claims

according to coordination of benefits guidelines.

Education

2001-2003 Samford University Birmingham, AL

B. A. General Studies Pre-Law

GPA: 3.5/4.0 scale

REFERENCES

Harriett Cooper Memphis, TN Phone: 901-***-****

George Williams Birmingham, AL Phone: 205-***-****

Cheryl Carter Birmingham, AL Phone: 205-***-****

Contact this candidate