ANDREA MASON
Blue Bell,PA
Summary
Organized and detailed Provider Data Specialist with proven history supporting complex business intelligence projects. Collaborative team player to partner cross-functionally to deliver solutions. Offering more than 5 years of experience in testing and troubleshooting systems.
Overview
23
23
years of professional experience
Work History
Provider Data Specialist
Independence Blue Cross
Philadelphia, PA
03.2019 - Current
- Investigate, analyze, and manage routine information on all PA, NJ, DE, MD providers
- Evaluate the unique provider contracting arrangements, financial arrangements, group affiliations and provider linkage affiliations, accreditation information, directory data, and reporting data
- Administer complex provider data changes, additions and terminations within the CPR/Provider Profiles system
- Reviewing provider credentialing status using HC3 – Credentialing
- Submits data fix tickets for the PDA staff in regard to system errors and problems
- Handles and manages audit reports
- Creates non-par and dummy numbers for claims payments
- Provide back-up to the supervisor, handling all supervisor issues, requests, priorities, projects, attending meetings
- Supervising the PDA team in the supervisor’s absence
- Training new associates and support staff on systems and policies
- Handle all contract parent/entity requests.
Business Specialist
Independence Blue Cross
Philadelphia, PA
08.2008 - 09.2017
- Participated in the generation of provider demographic profiles
- Analyze/process the incoming provider data received from Provider Profile releases
- Identify appropriate business areas to address the problems or handle requests
- Lead projects for but not limited to provider demographics, Philprov/CPR set-up, and failed fax research
- Attending meetings and providing status reports
- Worked closely with Business Analyst, Provider/Network Operations staff, and management to track and monitor business processes involved in processing provider demographic profiles
- Assisted in development of desk procedures and methods to effectively and efficiently maintain current and accurate data
- Support and complete testing for POMS/PCR enhancements
- Handling Intake, Processing, Incompletes, Undeliverables, and Provider Inquiries/INFOS
- Identify root causes and trouble-shoots issues
- Respond to business needs that may require research, evaluation, and documentation of findings
- Departmental Projects such as 1099 project, ICD 10 Outreach, 2016 PA and DE Fee Schedule Returns/PA Preventive Returns, and Provider Taxonomy Code Research, Failed Fax Research, and Creating claims inquiries.
ASO Provider Data Specialist
Independence Blue Cross
Philadelphia, PA
05.2006 - 08.2008
- Investigate, analyze, and manage routine information on Region 19 and Kentucky providers
- Evaluate the unique provider contracting arrangements, financial arrangements, group affiliations and provider linkage affiliations, accreditation information, directory data, and reporting data
- Administer complex provider data changes, additions and terminations within multiple systems
- Review provider data sheets and audit reports returned from providers, and enter data into systems
- Call PFFS providers to receive demographic information and to request W-9 forms
- Handle workflow coordinator duties for PFFS
- Receive all W-9 faxes and set up new provider records
- Organize and monitor all file folders for the W-9’s
- Use Intelliqueue, MHS, IPDW, CIS, and philprov records for payment
- Subject Matter Expert for the ASO unit on the Documentation Project using SharePoint, writing all procedures on every departmental process.
Government Programs Member Services Representative
Independence Blue Cross
Philadelphia, PA
11.2004 - 05.2006
- Receive incoming calls from members, providers, pharmacies, and lawyers answering their questions in a timely and accurate manner
- Document every call in a timely and accurate manner regarding the questions and problems such as: provider grievances, member appeals, pharmacy overrides, address changes, name corrections, date of birth corrections, enrollment, disenrollment of deceased members, plan changes, premium billing, group billing, claims, authorizations, mail out packets, and primary care physician office changes
- Knowledge of Medicare Parts A, B, and D, Medicaid, and CMS guidelines, Medigap Policies, Medicare Advantage Enrollment guidelines, Medicare Savings Programs, Pace, Pacenet, PAAD, the Medicare Prescription Drug, Improvement and Modernization Act of 2003, and HIPAA guidelines
- Handle Special Handling Issues for Medicare Part D- Prescription Drug Plans
- Contacting Medicare, Social Security, Eligibility Dept., and pharmacies determining member eligibility for plans and having members updated immediately in all systems
- Provide on the job training for new associates.
Workflow Coordinator
Independence Blue Cross
Philadelphia, PA
09.2001 - 11.2004
- Maintain all appeals, sorting, date stamping, and assigning appeals to coordinators, logging appeals into the project log, and entering appeals into the INFO system
- Research provider information and claims information, sorting, rerouting misdirected mail, copying, filing, and sending out acknowledgment letters to the providers
- Enter documents into the AIM system, using Oscar and MHS to research claims status.
Education
Roxborough High School
Accomplishments
- Best Business Student Award
References
References available upon request.
Timeline
Provider Data Specialist
Independence Blue Cross
03.2019 - Current
Business Specialist
Independence Blue Cross
08.2008 - 09.2017
ASO Provider Data Specialist
Independence Blue Cross
05.2006 - 08.2008
Government Programs Member Services Representative
Independence Blue Cross
11.2004 - 05.2006
Workflow Coordinator
Independence Blue Cross
09.2001 - 11.2004
Roxborough High School