Summary
Overview
Work History
Education
Skills
Timeline
Generic

Alyssia Blalock

Raleigh,NC

Summary

Proven specialist with a track record of enhancing the claims process at Aetna Inc., showcasing expertise in medical terminology and exceptional problem resolution skills. Leveraged documentation abilities and cross-functional teamwork to improve efficiency by 30%. Renowned for meticulous customer service and effective communication, consistently delivering results beyond expectations.

Overview

12
12
years of professional experience

Work History

Claims Benefit Specialist

Aetna Inc.
01.2019 - Current
  • Coordinated with contracting department to resolve payer issues.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Communicated effectively with staff, including members of operations, finance and clinical departments.
  • Acted as subject matter expert, answering internal and external questions and inquiries.
  • Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
  • Applied medical necessity guidelines; determines coverage; verified eligibility; identified discrepancies; and applied all cost containment measures to assist in claim adjudication processes.
  • Performed claims re-work calculations.
  • Identified and reported possible claims overpayments, underpayments, and irregularities.
  • Ensured compliance requirements were met.
  • Ensured payments were made in accordance with company practices and procedures.
  • Reviews pre-specified claims or claims which exceed specialist adjudication authority or processing expertise.
  • Ensures compliance requirements are satisfied, and payments are made in compliance with company practices and procedures.
  • Re-works claim payments.
  • Determines medical necessity and coverage as per guidelines; verifies eligibility; identifies discrepancies, and applies all cost containment measures to assist in claim adjudication processes.
  • Manages and monitors daily workflow and reporting to ensure business objectives are maintained and accurately reported; ensures resources are aligned appropriately across function and/or service center.
  • Follows a pattern of operations generally standardized, but frequently includes rules, expectations, and special instructions, which demand close attention to process claims.
  • Follows strict federal guidelines and state mandates to make determinations on claims.
  • Conducted comprehensive audits to identify areas of improvement within the claims process, leading to a more efficient system.
  • Reviewed policy coverage details thoroughly before making determinations on benefits eligibility for each unique claim scenario presented.

Application Helpdesk Analyst, Office Assistant

North Carolina Health & Human Services Commission
12.2016 - 12.2019
  • Tracked and recorded expenses and reconciled accounts to maintain accurate, current and compliant financial records.
  • Processed payments and documented account changes for financial accuracy and transparency.
  • Enhanced collaboration between team members by preparing meeting materials and taking clear notes to distribute to stakeholders.
  • Interacted with customers professionally by phone, email or in-person to provide information and directed to desired staff members.
  • Kept physical files and digitized records organized for easy updating and retrieval by authorized team members.
  • Coordinated, scheduled and arranged meeting and travel calendars, including business and social events.
  • Managed high levels of call flow and responded to various departments technical support needs.
  • Coordinated efficient calendars for 1 director and 4 Managers by factoring in schedule availability and load limitations.
  • Used Remedy ticketing systems to manage and process support actions and requests.
  • Organized all new hire, security and temporary paperwork.
  • Screened applicant resumes and coordinated both phone and in-person interviews.
  • Logged support tickets and closed when issues were resolved.
  • Generated system data to prepare and submit standard weekly/quarterly/monthly reports.
  • Coordinated with providers and claims to address payment discrepancies. Inquired about outstanding checks, stops, voids, replacements.
  • Processed incoming checks for deposit, state assessment, and other miscellaneous payments, and processed transaction in an access database.
  • Organized, compiled, researched, and analyzed provider accounts to identify credit balances.
  • Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
  • Identified trends and patterns in large datasets, leading to actionable insights for business growth.

Administrative Assistant

Department Of Public Safety
08.2012 - 08.2015
  • Coordinated bookkeeping activities in QuickBooks and Lawson, including invoicing and accounts payable.
  • Composed internal memos and external correspondence for senior management and reviewed all documentation to eliminate errors.
  • Developed and updated spreadsheets and databases to track, analyze and report on performance and sales data.
  • Performed research to collect and record warrant data.
  • Processed invoices and expenses to facilitate on-time payment.
  • Managed accounts payable and receivable for Riggers office grossing $50 to 75 thousand per year.
  • Created detailed expense reports and requests for capital expenditures.
  • Submitted requisitions for the next years budget.
  • Contacted outside agencies for balances owed to the Department of Public Safety.
  • Monitored the purchase of the police and riggers cell phones.
  • Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
  • Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.

Education

Bachelor of Arts - Liberal Arts And General Studies

North Carolina A & T State University
Greensboro, NC
05.2011

Skills

  • Documentation abilities
  • Reporting skills
  • MS Office
  • Problem resolution
  • Customer Service
  • Research
  • Filing, sorting, organization
  • Training
  • Quicken
  • Coding
  • Medical Terminology
  • Remedy, Alchemy, EDI
  • Experience working among cross-functional teams, as well as diverse groups
  • Excellent verbal, communication skills
  • QNXT 32, 48, 51, 52 and 535
  • AS400
  • NCIC
  • ACJIS

Timeline

Claims Benefit Specialist

Aetna Inc.
01.2019 - Current

Application Helpdesk Analyst, Office Assistant

North Carolina Health & Human Services Commission
12.2016 - 12.2019

Administrative Assistant

Department Of Public Safety
08.2012 - 08.2015

Bachelor of Arts - Liberal Arts And General Studies

North Carolina A & T State University

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Alyssia Blalock