Alexus Connelly
Columbia,USA
Summary
Utilizing the knowledge obtained through past experiences and applying those skills in efforts of growth and aligning with the company’s vision and standards. Also always following my Mission, Vision, and Values in all situations.
Professional with experience in healthcare administration, specializing in processing and managing medical claims. Skilled in data analysis, claim adjudication, and ensuring compliance with industry regulations. Strong focus on teamwork and achieving results through effective communication and adaptability to changing needs. Reliable and efficient in handling high volumes of claims while maintaining accuracy and confidentiality.
Overview
13
13
years of professional experience
Work History
Medical Claims Processor
Blue Cross And Blue Shield Of South Carolina
Columbia Sc
02.2022 - 11.2024
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Monitored and updated claims status in claims processing system.
Authorization Specialist
Blue Cross And Blue Shield Of South Carolina
Columbia Sc
02.2021 - 11.2022
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
Personal Phone Banker
Wells Fargo
07.2018 - 01.2021
- Processing complex transactions and performing extensive research to resolve in branch banker inquiries
- Interacting effectively with internal and external partners and clients/customers
- Assisting Bankers in the branch with stop payments on cashier’s checks and money orders, correcting any misrouted/missing deposits
- Rerouting funds to correct accounts
- Required basic computer skills including the ability to navigate multiple computer screens, Windows, applications and utilize search tools to find information
- Provided expert guidance on loan applications, ensuring clients understood repayment terms while helping them make informed decisions about their finances.
- Maintained up-to-date knowledge on bank products, services, and regulations to provide accurate information to customers.
Coordinator
American Red Cross
12.2014 - 05.2018
- Greeting donors as they come in, checking them in and scheduling future appointments
- Outbound calling to schedule Platelet and blood donors
- Always understanding the mission and having great customer service
- Making sure my team is making daily and weekly goal
- Coordinating reminder calls, follow ups, also doing data and maintenance of records
- Pulling charts and printing donor history
- Entered data, generated reports, and produced tracking documents.
- Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
- Managed project timelines for successful completion, ensuring milestones were met and deadlines were adhered to.
Teleperformance
11.2014 - 10.2016
- Giving great customer service
- Answering inbound calls
- Taking payments/troubleshooting call
- Making weekly sales goals
Lexington Family Practice
11.2011 - 11.2014
- Using computer applications
- Answering telephones
- Greeting patients
- Updating and filing patient medical records
- Filling out insurance forms/Faxing medical records
- Scheduling appointments
Education
Bachelor of Science - Nursing
South University
Columbia, SC11.2024
High School Diploma -
Blythewood High School
Columbia, SC01.2011
Skills
- HIPAA compliance awareness
- Medical record review
- Insurance claims processing
- Quality assurance checks
Career Overview
5, customer service, multiple P.O.S systems, Microsoft Office Word, Microsoft Office Excel, Microsoft Office PowerPoint, multiple Operating Systems, typing 60+ wpm
Timeline
Medical Claims Processor
Blue Cross And Blue Shield Of South Carolina
02.2022 - 11.2024
Authorization Specialist
Blue Cross And Blue Shield Of South Carolina
02.2021 - 11.2022
Personal Phone Banker
Wells Fargo
07.2018 - 01.2021
Coordinator
American Red Cross
12.2014 - 05.2018
Teleperformance
11.2014 - 10.2016
Lexington Family Practice
11.2011 - 11.2014
High School Diploma -
Blythewood High School
Bachelor of Science - Nursing
South University