Objective: Claims Quality Auditor / Financial Ops Recovery Specialist III
HIGHLIGHTS OF QUALIFICATIONS
Â§ Five years Medical Claims Auditor.
Â§ Able to handle complex case research and resolution
Â§ Able to interact with management and staff to ensure customer satisfaction.
Â§ Ability to solve problems with organizational skills.
Â§ Business oriented: Ability to understand and execute corporate policies and procedures.
Â§ Complete knowledge of end to end healthcare payer claims organization.
Â§ Blues ITS plan to plan claims processing, including Home, Host and Away From Home Care.
Â§ Team player.
Â§ Ten years Health Insurance
Â§ Knowledge of basic ICD-9, HCPCS and CPT codes.
Â§ Five years claims auditor.
Â§ Strong analytical skills.
Â§ Ten years health insurance.
Â§ Ability to recognize and address system issues.
Â§ Able to train new associates.
Â§ Four years customer service.
Â§ Microsoft Excel, Word and Access
Â§ BCBSA ITS Formats Database – Home and Host processing
Â§ AMISYS – Trainer, System Tester, Pricing audits, Membership, Claims and Phone Logs. Claims processing and adjustments.
Â§ BCBSA Away from Home Care – Set up membership, processed and adjusted claims, created spreadsheets for payment reimbursements and send accounts payable data.
Â§ WGS – BC of CA legacy system
May 2009 – Present Auditor CareCore National
January 2009 – May 2009 Caregiver Home Instead Senior Care
October 2008 – May 2009 Claims Specialist Insurance Overload Staffers
March 2007 – October 2008 Laborer/Janitorial Leasure Developments
December 2006 – January 2008 Caregiver In-Home Health Care
January 2002 – December 2006 Quality Auditor Anthem Blue Cross Blue Shield
January 1999 – December 2006 System Tester Anthem Blue Cross Blue Shield
January 1998 – December 2006 Amisys Trainer Anthem Blue Cross Blue Shield
November 1997 – December 2006 Claims Specialist Anthem Blue Cross Blue Shield
EDUCATION & TRAINING
Customer Service Training – Anthem Blue Cross Blue Shield
Office Education – Colusa California
George Washington High School – Tamuning, Guam