Alisha Norwood
Valrico,FL
Summary
Enthusiastic and eager to contribute to team success through hard work, attention to detail with excellent organizational skills. Successful at managing high caseloads in fast-paced environments. Organized, driven, and adaptable with excellent planning and problem-solving abilities. Offering 15 plus years of experience and willingness to take on any challenge.
Overview
16
16
years of professional experience
Work History
Provider Recon Analyst
Anthem BCBS
Mason, OH
07.2013 - 05.2022
- Ability to understand the application of benefit contracts, pricing, processing, policies, procedures, CMS regulations, coordination of benefits, & healthcare terminology.
- Researches and analyzes claim issues with resolution.
- Peer Mentor and Training Assistance
- Researching system issues and assisting other associates with their questions and concerns.
- Checked documentation for accuracy and validity on updated systems.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Processed and recorded new policies and claims.
- Posted payments to accounts and maintain records.
- Maintained confidentiality of patient finances, records and health statuses.
- Acted as subject matter expert, answering internal and external questions and inquiries.
- Coordinated with various departments to resolve payer issues.
- Reviewed outstanding requests and redirected workloads to complete projects efficiently and timely.
Revenue Recovery Specialist Manager
Health Management Associates
Sarasota, FL
12.2012 - 07.2013
- Manages primary contacts for resolution for major commercial and government entity health plans
- Develop reporting systems to manage, monitor, and report activities related to associate’s daily activities
- Supervising collectors and analyst productivity
- Training and coaching associates on daily performances ensuring associated are meeting productivity and quality standards by ensuring that all resources are in place for them to adequately be effective in their core responsibilities
- Viewing and distributing productivity reports to associates and management, providing trends and process improvements to control future occurrences
- Act as liaison between various departments.
- Review and identify payment variances, review contract loading, updates, and interpretation of payer contracts
- Identify payer trends, identify variances reasons and follow up on solutions to prevent future occurrences
- Interacts with various departments to correct data integrity errors, pre-certification discrepancies, coding issues, plan codes selections, and contract loading errors
- Responsibilities include compiling data, analyzing data, and making cursory recommendations
- Developing workout plans and strategies to maximize asset recoveries
- Ability to review and interpret medical records, appeal processes, documentation of root issues, and medical terminology
- Poses Strong interpersonal, written, and communication skills and other administrative responsibilities assigned.
Provider Service Specialist -Quality Auditor II
Amerigroup Community Care
Tampa, Florida
07.2009 - 11.2012
- (IRU) Auditor II, Responsibility include provide assistance to provider and billing agencies for assign products and/or plans
- Assists with benefits explanation, eligibility status, and problem payments, direct and assist providers and billing agencies in filing claims correctly and in timely manner
- Responsible for verifying coverage and benefits for providers and claimants
- Responsible for performing data entry skills as well as clerical skills
- Reviewed and processed medical health claims for Self Insured Groups including verification of coverage, COB and adjudication of claims
- Maintain proficiency in assign queues
- Handle complex adjustment needs, analyze claims inquires and claims as appropriate per fee schedule, authorizations, Single Case Agreements, and contracts
- Evaluate encounter and claims submission for completeness, program eligibility status, medical appropriateness and consistency
- Providers first call resolutions to LTC markets
- Responsible for processing all entry level as well as complex level transactions
- Meet and exceed established quality standard for financial accuracy rate (FAR), Statistical Data Assurance (SDA), and Overall Accuracy Rate (OAR) and call handle quality.
Customer Service/Claims Representative
United Health Group
Tampa, Florida
09.2007 - 07.2009
- Provide telephonic assistance to members and providers concerning escalated issues, claim disputes, medical appeals, negative balance research, and other claims inquiries.
- Responded to complex calls, resolved inquiries including claims status, rerouting claims to appropriate department, verifying benefits, and eligibility information for providers and members;
- Maintained good relationships with customers and providers.
Claims Processor III
Concentra/Coventry Health Care
Tampa, Florida
07.2006 - 07.2007
- Review and correct errors on records rejected from internal system; maintain productivity and quality standards as determined by business needs;
- Settled claims within authority levels and maintained caseloads of 200+ claims, examined, adjust, and approve claims for workers' compensation benefits.
- Maintains quality assurance program to support total performance management initiative and consistently delivered quality claims service
- In-depth knowledge of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices
- Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem-solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.\
Education
High School Diploma -
Robinson High School
Tampa, FL05.1999
Skills
- Insurance Claim Forms Review
- Analyzing Information
- Payment and Investigation Escalations
- Work Organizing and Prioritizing
- Verbal Communication Skills
- Regulatory Compliance Adherence
- Policy and Procedure Explanations
- Large-Sum Computations
- Coaching & Mentoring New hires
- Excellent critical and analytical skills
- Customer Service Skilled
- Strategic planning
- Analyzing and problem solving
- Developing, coordinating, or delivering training materials
- Basic PC skills
Timeline
Provider Recon Analyst
Anthem BCBS
07.2013 - 05.2022
Revenue Recovery Specialist Manager
Health Management Associates
12.2012 - 07.2013
Provider Service Specialist -Quality Auditor II
Amerigroup Community Care
07.2009 - 11.2012
Customer Service/Claims Representative
United Health Group
09.2007 - 07.2009
Claims Processor III
Concentra/Coventry Health Care
07.2006 - 07.2007
High School Diploma -
Robinson High School
Similar Profiles
Shawn SmithShawn Smith
Customer Service Representative III at Anthem BCBSCustomer Service Representative III at Anthem BCBS
Vivian GreenVivian Green
Member Services Advocate at ANTHEM BCBSMember Services Advocate at ANTHEM BCBS
Cecilia CruzCecilia Cruz
Program Administrator at Anthem BCBSProgram Administrator at Anthem BCBS