Alexis Titus
Cheshire,CT
Summary
Energetic and enthusiastic insurance professional motivated to succeed in fast-paced and deadline-driven professional environment. Comprehensive knowledge of claims processing and adjustments with special knowledge of Commerical and Medicaid guidelines.
Overview
18
18
years of professional experience
Work History
Claims Examiner
Amerihealth Caritas
Jacksonville, FL
08.2021 - 11.2023
- Review, research, analyze, and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing, verify pricing, prior authorizations, and applicable benefits
- Meet department quality and production requirements
- Creates and supports a professional environment which fosters teamwork, cooperation, respect, and diversity
- Process claims for multiple Lines of Business as requested by management
- Identified and resolved inconsistencies
- Checked claims for completeness and accuracy prior to final entry.
Claims Examiner
Dell Services/NTT Data
09.2020 - 08.2022
- Returned claims requesting missing information in accordance with quantity, quality, and timeliness guidelines
- Reviewed and resolved Medicaid and Medicare disputes
- Confirmed accuracy of appeals data received for review
- Utilized guidelines to determine status of appeals.
Desk Examiner
EA Renfroe
01.2017 - 01.2018
- Handled high volume inbound calls pertaining to Hurricane Irma catastrophe
- Evaluated complex claims
- Collaborated with adjusters to collect claim information
- Explained and negotiated settlements with insured and representatives.
Claims Examiner
Dell Services/NTT Data
01.2015 - 01.2017
- Returned claims requesting missing information in accordance with quantity, quality, and timeliness guidelines
- Reviewed and resolved Medicaid and Medicare disputes
- Confirmed accuracy of appeals data received for review
- Utilized guidelines to determine status of appeals.
Adjustments Team Lead
Blue Cross Blue Shield of Louisiana
Baton Rouge, LA
01.2011 - 01.2014
- Trained department on new procedures and processes
- Set daily performance goals and identified work process solutions
- Reviewed, researched and adjusted ARs, memos, recons, financial investigations and MSPs
- Utilized the medical configurator to ensure claims were accurately priced by DRG
- Processed local contract coverage changes
- Priced DME
- Recalculated benefits of claims with incorrect codes or processed incorrectly.
- Offered additional training and support to keep team members motivated and working toward objectives.
Adjustment Processor & Special Claims Processor
Blue Cross Blue Shield of Louisiana
01.2006 - 01.2011
- Entered coded information
- Returned claims requesting missing information in accordance with quantity, quality and timeliness guidelines
- Identified and resolved inconsistencies
- Reviewed claims for completeness and accuracy prior to final entry
- Recalculated benefits of claims with incorrect codes or processing for hospital, professional, major medical, Medicare and dental.
Education
Graduate -
McKinley Senior High School
Skills
- 45 WPM
- Adaptable
- AIE/CIE/PIE
- Amisys
- Analyzer
- Clear verbal and written communication
- Collaborator
- Dental
- Empathetic
- Facets Subject Matter Expert
- Federal
- HMO/POS/PPO
- Interpersonal
- Leadership
- Legacy
- Medicaid/Medicare
- Microsoft Office
- Patience
- Problem solver
- Quick Learner
- Self-control
- Self-motivated
- Time management
Locations
- Alabama
- Florida
- Georgia
- Louisiana
- North Carolina
- South Carolina
Timeline
Claims Examiner
Amerihealth Caritas
08.2021 - 11.2023
Claims Examiner
Dell Services/NTT Data
09.2020 - 08.2022
Desk Examiner
EA Renfroe
01.2017 - 01.2018
Claims Examiner
Dell Services/NTT Data
01.2015 - 01.2017
Adjustments Team Lead
Blue Cross Blue Shield of Louisiana
01.2011 - 01.2014
Adjustment Processor & Special Claims Processor
Blue Cross Blue Shield of Louisiana
01.2006 - 01.2011
Graduate -
McKinley Senior High School