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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.
Skills
  • 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.
Education
2003
High School Diploma:
Joseph P. Keefe Technical High School - Framingham, MA
  • Emphasis in Business Technology, Office Procedures and Accounting
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Skills
  • 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




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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.
Education
Bachelor of Science: Health Administration Eastern Michigan University - Ypsilanti, MI
Associate of Arts: Liberal Arts Macomb Community College - Warren, MI
Accomplishments
30 credit hours toward Master of Science in Business Administration
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Summary

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.
Education
MBA: Aviation Management, May 2017
EMBRY RIDDLE AERONAUTICAL UNIVERSITY - FLORIDA, USA


  • Graduated top 2% of the Global Business Strategy Game
  • 3.81 GPA
Bachelor of Science: FINANCE, DECEMBER 2011
AMERICAN UNIVERSITY OF NIGERIA - ADAMAWA, NIGERIA
  • Thesis: The Role Of ATM machines in the banking industry
  • Member of Students In Free Entrepreneurship (SIFE)
  • Student government representative
Skills
  • 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
Certifications

Global Business Strategy Game Certified.

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

This resume is created in 7 minutes.
Summary

[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.  

Skills
  • 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
Experience
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