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Work Background
Included HealthLead, Claims
Apr. 2023
Included HealthActing Team Lead - Enterprise Support
Jul. 2022 - Mar. 2023Identify implementation and/or partnership issues and create detailed tickets for escalation Act as Subject Matter Expert for Department Coordinate team workflows Identify changing priorities and ensure Urgent issues are addressed in a timely manner. Partner with other departments to identify improvement opportunities and improve workflow and communication between teams Work with account managers to resolve escalations from clients/employees Monitor Real Time Eligibility logs and place "Downtime Events" when transactions are failing Work with Revenue Cycle Management to ensure workflows between departments are updated. Responsible for working in case queue to resolve member inquiries related to insurance and/or employer partnerships.
Included HealthEnterprise Support Coordinator
May. 2021 - Mar. 2023Identify implementation and/or partnership issues and create detailed tickets for escalation Create receipts File and cancel claims/claim corrections Issue refunds for overpayments Work with account managers to resolve escalations from clients/employees Monitor Real Time Eligibility logs and place "Downtime Events" when transactions are failing Review invoices and compare to updated Provider Remits - update invoicing as needed Work with Revenue Cycle Management to ensure workflows between departments are updated. Responsible for working in case queue to resolve member inquiries related to insurance and/or employer partnerships.
Doctor On DemandProvider Support Agent Tier 2
Oct. 2020 - May. 2021Responsible for call queue needs and emails from members & clinicians regarding scheduling, prescriptions and other health care coordination needs Provide support to clinician staff to ensure patients obtain the appropriate care in a timely manner Use established protocols to identify and escalate priority issues that need immediate attention Clinician tier 1 technical troubleshooting to clinicians and members
Health Care Service CorporationSr. Tech
Jan. 2012 - Sep. 2020• Identify incoming records and route to correct team for medical determination. • Apply medical review determination to claims and verify provider and patient notifications are sent out. • Identify when claims are not processing per benefits and manually process to ensure correct payment. • Handle special reports for smaller states to ensure timeliness goals are met. • Became the go-to person when new claim interface was released. • Maintained over 95% accuracy for claims processing since 2013.
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