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Professional Summary
Seeking a position in healthcare where I can utilize my claims processing skills and insurance knowledge to help patients and clients better understand their insurance benefits.
  • Bilingual in English and Spanish
  • Microsoft Office Suite Programs proficiency
  • Lotus Notes
  • Records management professional
  • Excellent problem solver
  • Medical billing / coding and claims processing (HCPC, CPT, REV CODES, HCFAs, UBs and ICD 9 and 10)
  • CPR / BLS Certified
  • Basic pharmacology knowledge
  • Research and data analysis
  • Resourceful and reliable worker
  • Adept multi-tasker
  • Comprehensive knowledge of medical office procedures and requirements (HIPAA / OSHA / CLIIA)
Work History
02/2016 to 04/2017
Insurance Claims Specialist Allstates Medicaid Milford, MA
  • Provided customers with courteous, friendly, fast and efficient service.
  • Contacted patients to schedule medication deliveries and verify correct address information.
  • Contacted insurance companies to determine status of claims investigation and coverage eligibility.
  • Corrected and resubmitted rejected Third Party claims according to individual insurance plan requirements to receive payment in an efficient manner.
  • Assisted patients with the enrollment process for manufacturer and non-profit organization funded copay assistance programs.
03/2013 to 08/2014
Health Claims Analyst International Union Operating Engineers - Local 4 Medway, MA
  • Electronically processed medical claims from Blue Cross Blue Shield of Massachusetts.
  • Resolved provider inquiries relating to billing and payment patiently and efficiently.
  • Clarified medical, dental, prescription, and vision benefit information for members.
  • Maintained provider databases using Microsoft Excel and other accounting software platforms.
  • Researched and adjudicated claims that were not able to be auto-adjudicated based on complexity.
04/2006 to 07/2010
Provider & Pricing Team Lead / Customer Service Representati Health Plans, Inc / Harvard Pilgrim Health Care Westborough, MA
  • Contributed to superior customer service by processing claims efficiently and effectively in response to provider, client, and group member requests.
  • Ensured electronic databases were up-to-date with the most current provider information.
  • Maintained current knowledge of provider billing procedures and contracts for accurate pricing and payment.
  • Exported data from our intranet into Excel format to submit to external partners for claims pricing.
  • Provided assistance settling claim pricing errors and omissions using research and problem solving skills.
High School Diploma:
Joseph P. Keefe Technical High School - Framingham, MA
  • Emphasis in Business Technology, Office Procedures and Accounting
This resume is created in 7 minutes.
  • Strong presentation skills
  • Experienced managing projects
  • Knowledgeable in Microsoft Excel, Word, Outlook
  • Ability to define problems, collect data, establish fact, draw valid conclusions
  • Excellent Interpersonal, communication, writing skills
  • Resourceful, committed, driven team player
  • Strong customer service skills
  • Ability to read and  interpret extensive variety of documents
Work History
Hospital Claims Analysts Bottom Line Systems - Crescent springs, KY 10/2014 - Current
  • Identified contractual issues that contributed to 3.2 million in client underpayment.
  • Reviewed insurance contracts to gain a better understanding of payment methodologies that led to underpayment.
  • Prepared and submitted correspondence such as letters, appeals, and inquiries.
  • Defined contractual issues that led to underpayment.
  • Prepared reports that identified underpayment and payment methodology.
  • Built strong, lasting relationships with clients, payers and co workers.
Substitute Teacher Professional Educational Group - Burton, MI 09/2007 - 10/2014
  • Developed lesson plans and presented material in an effective, professional, and coherent style.
  • Applied appropriate teaching strategies in the classroom with various skill levels.
  • Ability to lead and interact positively with co-workers and parents.
  • Prepared reports and collect data as needed.
Provider Relations Coordinator SelectCare Inc. - Troy , MI 05/1991 - 05/1997
  • Managed contract negotiations between hospital, physicians, and ancillary providers.
  • Educated providers on health care products.
  • Conducted meetings and presentations on newly developed product.
  • Took on leadership role to provide accurate client payment


Provider Relations Representative Connecticut General Life Insurance Company - Southfield, MI 08/1988 - 01/1991
  • Developed a national network of mental health providers.
  • Managed contract negotiations for 17 states.
  • Educated providers on managed care contract.
  • Engaged in contract resolution.
Claims Analyst Connecticut Life Insurance Company - Southfield, MI 07/1986 - 08/1988
  • Accurately processed medical claims.
  • Positively engaged in problem resolution with providers and enrollees.
  • Prepared correspondences to providers and enrollees.
Bachelor of Science: Health Administration Eastern Michigan University - Ypsilanti, MI
Associate of Arts: Liberal Arts Macomb Community College - Warren, MI
30 credit hours toward Master of Science in Business Administration
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MBA graduate strong focus on aviation services/management. Good  knowledge of the Aviation industry and practices.

Work History
Senior Billings And Contracts Analyst, 06/2018 to Current
Menzies AviationFort Worth, TX
  • I ensure all contracts are set up according to  IATA ground handling manual.
  • I am responsible for setting up contract terms and rates in company revenue system.
  • Oversee monthly billing revenue of over $2 million at 7 airports.
  • Conduct a monthly credit analysis and present findings to upper management.
  • Managed a database of all airlines serviced at : CVG, ORD,SEA, MKE, SNA, SLC, IND.
Risk And Claims Analyst, 07/2017 to 06/2018
Menzies AviationDallas, TX
  • Assisted in development of Risk Management processes and procedures
  • Ensured all insurance claims were entered into the risk database in a timely manner.
  • Prepared OSHA logs on all accidents on and off ramp
  • Prepared monthly KPI's to provide a detailed break down of all workers compensation related injuries.
  • Worked closely with insurance brokers to ensure all insurance certificates and coverage were up to date for all business units.
  • Maintained and updated an asset database.
MBA: Aviation Management, May 2017

  • Graduated top 2% of the Global Business Strategy Game
  • 3.81 GPA
Bachelor of Science: FINANCE, DECEMBER 2011
  • Thesis: The Role Of ATM machines in the banking industry
  • Member of Students In Free Entrepreneurship (SIFE)
  • Student government representative
  • Extremely organized
  • Critical thinker
  • Data Analysis and Management
  • Contract auditing
  • Risk management processes and analysis
  • Materials preparation And Research
  • Process implementation and improvement
  • Budgeting and finance
  • Data management
  • Pricing tool development
  • Client assessment and analysis
  • Aircraft systems
  • Interpersonal and written communication
  • User interface understanding
  • Data entry

Global Business Strategy Game Certified.

OSHA 30 HOUR : General Industry Safety and Health Training , and Construction Safety and Health (In training).

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[Configuration Business Analyst]  Versed in configuration of pricing contracts and benefits based on the customers requests.  Self-motivated and dependable while achieving high performance with minimal supervision.  

  • Critical thinking proficiency
  • Excel
  • In-depth claims knowledge
  • Claims analysis and review specialist
  • SQL
  • Coordination of benefits
  • Financial aptitude
  • Broad knowledge of medical terminology
  • General customer services
  • Word
  • Outlook
  • Chemical testing
  • Fire protection system testing
  • Electrical circuit testing
  • Associated Press style proficiency
  • Automated testing methodologies
  • Bacteriological testing
  • Stress testing
  • Proficient in [Type] testing
  • Microsoft Certified Solutions Associate (MCSA): [Name of Microsoft technology]
  • Hematology testing aptitude
  • CISCO Certified Network Associate (CCNA)
  • Compatibility testing
  • Microsoft Certified Solutions Associate (MCSA) Certificate
  • Drug testing
  • Psychiatric testing
  • Design testing
  • Lab testing
  • Abrasion testing
  • Mechanical testing instruments
  • Materials testing
  • Testing devices
  • Patient testing and assessment
  • Boiler testing
  • Transformer, disconnect switch and ground grid testing
  • Testing efficiencies
  • Automated testing
  • Leak testing
  • [Type] testing
  • Static testing
  • Quality testing procedures
  • Environmental quality testing
  • Emissions testing
  • Verification and testing
  • Equipment testing and troubleshooting
  • Remote testing
  • Launch testing
  • Western Blot testing
  • Inspections and testing
  • Performance and reliability testing
  • Testing [Area of study] comprehension
  • Histochemical testing
  • Battery testing
  • Technology-driven testing
  • Web-based testing
  • Mechanical testing
  • Certified Technical Analyst
  • [Type] testing devices
  • Preliminary testing
  • Ophthalmology testing
  • [Type] testing experience
  • Regression testing management
  • Glucose testing
  • [Type] equipment testing
  • TABE testing
  • Game testing
  • Usability testing
  • Confirmation and prevalence testing
  • Electrical testing knowledge
  • Diagnostic testing
  • QA testing and automation
  • Lab testing protocols
  • Black box testing tools
  • Injection mold testing
  • Routine patient testing
  • Operational testing
  • Disease testing
  • Testing and diagnostics
  • Operations testing
  • [Type] testing and analysis
  • Components testing
  • Software system testing
  • Flow rate testing
Business Analyst II 04/2019 12/2019 Centene Corp Tempe, AZ

Enhanced claim adjudication protocol by partnering with business analysts to develop and or update pre-existing pricing contracts and benefits based on customers requests and requirements. 

Associate Testing Analyst 06/2013 10/2017 Aetna Phoenix, AZ

Tested various projects for the company software to ensure it was kept up to par. Tested for payments, contracts, and software updates. Ensured the product testing was complete and of high quality prior to sign off. Validated actual test results vs. expected results. Proactively escalated issues and delays in testing. Built and maintained relationships with Health Plans, Information Technology, Provider and Configuration team, by keeping them informed about projects and maintaining workload based on priorities.

Quality Review Analyst 10/2008 07/2013 Aetna Phoenix, AZ

Provided quality auditing of processed medical claims by claims department.  Assigned errors if applicable. Provided feedback to claims analyst on error assigned.

Claims Analyst II 04/2004 09/2008 Schaller Anderson/Aetna Phoenix, AZ

Adjudication of Mercy Care claims using online company contracts. Resolved edits and verified high dollar claims. Adjusted claims to pay correctly.

Claims Examiner II 11/2002 04/2004 UnitedHealth Care Phoenix , AZ Adjudicated Medicaid claims for the state of New Jersey using online company contracts.  Resolved multiple exception codes depending on how client paid.  Verified and adjusted high dollar claims.
Education and Training
05/1992 High School Diploma: Gilbert High School Gilbert, AZ
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Professional Summary
Customer Service Representative focused on resolving user software inquiries across a variety of platforms seeking to bring outstanding technical knowledge to a rapidly growing startup.
Work History
Line Service Technician, 11/2015 to 02/2017
BBA Aviation Saint Louis, MO
  • Accompanied aircraft as a member of the flight crew in order to monitor and handle cargo in flight.
  • Calculated the aircraft weight and balance, performance and fuel requirements.
  • Checked to ensure that food, beverages, blankets, reading material, emergency equipment and other supplies were aboard.
  • Maintained air-to-ground and point-to-point radio contact with aircraft commanders.
  • Issued landing and take-off authorizations.

Automotive Service Advisor, 09/2014 to 11/2015
BSRO; FCAC Saint Louis, MO
  • Followed checklists to verify that all important parts were examined.
  • Communicated with customers regarding vehicle issues and potential repairs.
  • Maintained a 90% customer service satisfaction rating.
  • Organized work records and filed reports.
  • Reviewed the work of 6 auto mechanics.

Mechanical Claims Analyst, 05/2010 to 09/2013
Jim Moran & Associates Earth City, MO
  • Provided customer service for an average of 50 calls per day, answering customer inquiries, solving problems, and providing new product information.
  • Answered questions regarding company and products, while maintaining knowledge of current sales and store promotions.
  • Guaranteed positive customer experiences and resolved all customer complaints.
  • Directed calls to appropriate individuals and departments.

Field Technician, 03/2017 to Current
Charter Spectrum Overland, MO
  • Resolved an average of 7 technical inquiries each day.
  • Programmed and troubleshot devices following installation.
  • Calibrated and monitored devices following installation.
  • Recommended system-level hardware and software installations.

Associate of Applied Science: Automotive Mechanics, 2012
Ranken Technical College - Saint Louis, MO

Associate's DegreeHigh School Diploma: 2009
RockBridge High School - Columbia, MO
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Professional Summary
Driven finance and banking professional effective at maximizing customer service opportunities while exceeding individual performance goals and while adhering to all lawsunder the Consumer Credit Protection Act (CCPA).
  • Strong banking ethics
  • Deep knowledge of bankruptcy processes
  • Goal-oriented
  • Self-sufficient
  • Positive attitude
  • Flexible
  • Team player
  • Customer Service
  • Professional Customer Interactions
  • Maintains Positive Attitude
  • Excellent Time Management
  • Excellent Communicator
  • Credit Management
  • Complex Financial Issues
  • Credit Reports
  • Retail Mortgage Lending
  • Loan Products
  • State Compliance Guidelines
Work History
Mortgage Loan Processor Wipro (Discover Bank) - Atlanta, GA 11/2016 - 04/2017
  • Recommended loan approvals and denials based on customer loan application reviews.
  • Maintained current loan and pricing information on the online banking website.
  • Originated, reviewed, processed, closed and administered customer loan proposals.
  • Compiled database of loan applicants\' credit histories, corporate financial statements and other financial information.
  • Successfully closed an average of30 loans per month.
  • Reviewed and edited loan agreements to ensure accuracy.
  • Complied with regulatory requirements, including the Bank Secrecy Act, Anti Money Laundering, OFAC, USA Patriot Act, Privacy Act and Community Reinvestment Act.
  • Received “Employee of the Quarter” service award.
  • Conducted UCC searches and created environmental reports as part of the loan process.
  • Maintained strict confidentiality of bank records and client information.
  • Maintained friendly and professional customer interactions.

Commercial Claims Analyst Bank Of America - Phoenix, AZ 02/2015 - 03/2016
  • Reviewed and analyzed suspicious and potentially fraudulentcredit cardclaims.
  • Evaluated all evidence with the ultimate goal of creating positive outcomes for client\'s claims.
  • Substantiated legitimate claims and denied unjustified claims.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Collaborated with the claims department and industry anti-fraud organizations to resolve claims.
  • Created new processes and systems for increasing customer service satisfaction.
  • Answered an average of60 claimsper day by addressing customer inquiries, solving problems and providing new product information.

Collector II Bank Of America - Kennesaw, GA 10/2013 - 02/2015
Collected in both Inward and Outward (30day – 180day) Consumerand Business Responsible for collecting apredetermined percentage of a book of business on a monthly basis Maximizing calling efforts and being effective on the dialer without deviating from the outlined daily strategy Excellent settlement negotiator and verifier
  • Excellent Communicator
  • Time Management
  • Credit Management
  • Financial Analysis
  • Loan Products

  • Mortgage Loan Coordinator Foundation Financial Group - Atlanta, GA 05/2012 - 08/2013
    • Customer Service
    • Sales Expertise
    • Mortgage Industry Standards
    • Maintained current loan and pricing information on the online banking website.
    • Recommended loan approvals and denials based on customer loan application reviews.
    • Maintained friendly and professional customer interactions.

    Sales Associate AT&T - Birmingham, AL 09/2008 - 12/2011
    • Managed a portfolio of250 accounts totaling $500,000 in sales.
    • Effectively led a seasoned team of partner managers and account coordinators.
    • Oversaw sales forecasting, goal setting and performance reporting for all accounts.
    • Collaborated with other account managers to prepare and deliver performance updates and quarterly business reviews.
    • Wrote sales contracts for orders obtained and submitted orders for processing.
    • Prioritized daily workflows, including all inbound calls, quotes and sales-related inquiries.
    • Exceptional Interpersonal Skills
    • Customer Inquiries
    • Customer Needs
    • Team Player
    • Outbound Telephone Marketing
    • New Customers
    • Inbound Calls
    • Specific Products
    • Dedicated Team Player

    Mortgage Loan Processor Maximum Mortgage - Birmingham, AL 05/2005 - 09/2008
    • Adhered to all federal and state compliance guidelines relative to retail mortgage lending.
    • Provided expert financial advice on mortgage and both educational and personal loans.
    • Recommended loan approvals and denials based on customer loan application reviews.
    • Assisted senior-level credit officers with complex loan applications.
    • Originated, reviewed, processed, closed and administered customer loan proposals.
    • Compiled database of loan applicants\' credit histories, corporate financial statements and other financial information.
    • Performed daily maintenance of the loan applicant database.
    • Developed and maintained relationships with local real estate agents.
    • Analyzed applicants\' financial status, credit and property evaluation to determine feasibility of granting loan.
    • Submitted loan applications to the underwriter for verification and recommendations.
    • Determined appropriate rate locks, issuance of disclosures, overage and underage waivers and fee waivers.
    • Educated customers on the variety of loan products and available credit options.
    • Reviewed and edited loan agreements to ensure accuracy.
    • Executed the loan origination process, including ordering credit reports, appraisals and preliminary title reports.
    • Researched insurance information and flood certificates.

    Bachelor of Arts: Communications Alabama State University - Montgomery, AL
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    Professional Summary
    Meticulous Provider Data Specialist, excellent at juggling multiple tasks and working under pressure. Broad industry experience in managed healthcare. Familiar with Microsoft Suite, SharePoint, and various other systems. Ability to remain focused and productive each day though tasks may be repetitive.
  •  Strong technical skills (Microsoft Windows
  • strong systems aptitude
  • etc.)
  • Exceptional communication skills
  • Customer Service
  • Knowledge of coding (ICD-9
  • Self-motivated
  • keyboarding skills
  • advanced Microsoft Excel knowledge
  • Strong client relations
  • Medical terminology knowledge
  • Health Information Management
  • ICD-10
  • CPT)
  • Knowledge of medical claim forms (HCFA/CMS and UB).
  • Work History
    08/2013 to 09/2017
    Provider Information Specialist Molina Healthcare of Texas Irving, TX
    • Oversees  receipt of information from providers for update of information in computer system(s)
    • Analyze by applying knowledge and experience to ensure appropriate information has been performed. 
    • Load and maintained provider information into computer system(s) with attention to detail and accuracy in a timely manner to meet department standards and turnaround time and quality. 
    • Audits loaded provider records for quality and financial accuracy and provides documented feedback. 
    • Assists in configuration issues with corporate team members. 
    01/2011 to 08/2013
    • Provide Superior Customer Service to providers.
    • Answer and/or return all incoming calls within 4 hours to providers and customer service inquiries.
    • Provide by mail, fax or email copies of EOR's to provider when necessary.
    • Ensure proper follow-up and customer communication when appropriate.
    • Prescreen claims for the purpose of applying preauthorization of rules according to ODG guidelines.
    • Prepare Claims for entry, applying the proper denial code for no preauthorization.
    • PLN, PEER, RME, DDE, IRO and other report entry into system annotation history for all client claims.
    06/2010 to 01/2011
    Claims Adjuster Assistant Questpro / QTemps Health Direct Inc Dallas, TX
    • Utilized adjuster knowledge by assisting and providing clerical and administrative support to a group of Worker's Compensation Case Managers.
    • Accurately set up new requests for medical services from providers in order to treat the injured employee via EDI, utilizing knowledge of medical and insurance terminology, ICD-9, and CPT 4 codes.
    • Managed incoming calls from medical providers, legal staff, and claimants in reference to the injured employee.
    • Customer Service duties demonstrated while taking incoming and making out going calls. 
    01/2007 to 01/2010
    Claims Processor/ Workers Compensation Injury Management Organization Carrollton, TX
    • Medical Bill Review Clerical Support Team Lead / Medical Prescreen.
    • Managed prescreening for the purpose of applying preauthorization of rules according to ODG guidelines.
    • Managed the SFI (scan file index) functions to ensure that the appropriate Quality Assurance (QA) was being provided.
    • Established and maintained relationships with all clerical staff to ensure knowledge of their accounts, process and workflows from all levels.
    • Assisted with annotations, interface of medical claims with Medical Bill Review.
    • Managed employees and worked with management to proactively evaluate staffing needs.
    • Oversight of performance reviews, training and relationship building.
    01/2006 to 01/2007
    Customer Service/Collections Specialist Ancillary Care Service, dba American Care Source Holdings Dallas, TX
    • Re-priced and reported savings on claims for contracted insurance participating with ACS PPO networks.
    • Processed payments from insurance to send to participating providers.
    • Quality assurance on claims to ensure they were sent out clean also on payments to ensure providers were paid correctly.
    • Answered incoming calls from providers that wanted to check status of claims that were re-priced and billed on their behalf.
    03/2006 to 07/2006
    Medical Claims Reviewer Insurance Overload Services Inc Dallas, TX
    • Performed data entry of provider generated HCFA 1500 and UB 92 hospital bills.
    • Audited company generated Explanation of Benefits for accuracy of ICD-9 CPT 4 and HCPCS codes.
    • Made contact with providers for missing billing information per company protocol.
    • Performed special assignments related to claims processing/bill review as directed by supervisor or team lead.
    01/1999 to 01/2005
    Medical Claims Reviewer Fair Isaac Corporation Coppell, TX
    • Performed data entry of provider generated HCFA 1500 and UB 92 hospital bills4.
    • Audited company generated Explanation of Benefits for accuracy of ICD 9, CPT 4 and HCPCS codes.
    • Made contact with providers for missing information per company protocol.
    • Performed data entry duties of claims form from KFI/OCR (key from image/optical critical repair) data base.
    • Performed scan room duties of placing provider claims forms into KFI/OCR database by way of Kodak scan equipment.
    • Performed mail room duties of company generated information to providers and clients notifying of status of submitted claims.
    • Performed back up duties of processing incoming claims for the purpose of preparing claims to be coded and data entered into database.
    • Performed back up customer service duties receiving and making calls to providers and clients.
    01/1994 to 01/1999
    Customer Service Rep / Medical Claims Analyst Intracorp Irving, TX
    • Answered incoming calls from plan participants regarding pre-authorization of medical procedures and admissions as outlined by healthcare carrier.
    • Made outbound calls to healthcare facilities verifying dates of discharge.
    • When guided through by company software and criteria, authorized office visits and surgical procedures for plan participants.
    • Audited incoming provider claims with the purpose to ensure prior authorization was given from carrier to provider for specific procedures and medical equipment according to Texas Workers Compensation rule 134.600.
    • Prepared incoming claims for data entry staff by batching and labeling claims.
    • Performed back up data entry duties of overflow claims as directed by supervisor or team lead utilizing the Texas Workers Compensation fee schedule.
    April 2018
    Bachelor of Science: Health Information Management
    Southern New Hampshire University - Hooksett, NH
    April 2018
    Bachelor of Science: Health Information Management
    Southern New Hampshire University - Hooksett, NH