Beth R Canole
Platte City
Summary
Healthcare professional skilled in managing and validating provider data to ensure operational efficiency. Expertise in maintaining databases and implementing data integrity measures. Known for collaborative teamwork and adaptability in dynamic environments. Strong analytical skills and attention to detail.
Overview
30
30
years of professional experience
1
1
Certification
Work History
Provider Data Specialist
Blue Cross Blue Shield of Kansas City
04.2023 - Current
- Interacts with all appropriate areas of the company to effect provider changes.
- Follows established team practices for documentation, communication of changes to stakeholders, and monitoring personal and team workflows to make adjustments for backlogs and expediting as needed to maintain compliance.
- Interacts with all appropriate areas to resolve provider-related operational issues, including claims routed to MCO, customer service inquiries, ASK verifications, EFT and ERA setups, return mail & checks, uncashed checks, IRS/TIN matching errors, dental GRID error reports, etc.
- Coordinates the processing of all BlueCard/Host transplant-related claims for donors and recipient. Collects all claims related to the global services working with Case Management, making necessary claim adjustments/recoupments, documenting and transmitting to the home plan for payment. Responds to all follow-up and adjustment requests from the home plan.
- Coordinates the processing of all single-case agreement exceptions approved by Blue KC contracting. Claims are manually routed and collected for review, and write-up instructions are provided to Operations for pricing the claims.
- Responds to inquiries (internal/external) regarding provider or facility contracting pricing questions, system pricing issues, etc. Interacts with all appropriate areas to resolve provider or facility-related operational issues, including claims routed to MCO, customer service inquiries to explain claim payment pricing, manual pricing instructions, and interpretation of appropriate pricing.
Member Services Billing and Eligibility
Blue Cross Blue Shield of Kansas City
01.2015 - 04.2023
- Worked with enrollment, maintenance, billing, and reconciliation for direct pay and small group policies.
- Process member eligibility and billing-related updates received electronically or via written correspondence using knowledge of company software tools (e.g., Facets, automated work distribution system, etc.) as well as relevant Federal and State regulations and/or company business rules.
- Maintain member accounts by processing, for example, refunds timely in order to keep receivable and payable accounts current.
- Apply written instructions from established Standard Operating Procedures (SOPs), Start-up notes, and remote and in-person training following as needed.
- Evaluate and problem-solve routine eligibility and billing issues using job knowledge.
- Escalates identification of non-routine eligibility and billing problems or process gaps to management.
Customer Service 2-10.1
Blue Cross and Blue Shield of Kansas City
10.2011 - 01.2015
- Work with affordable Care Act and Exchange daily, take member payments, billing.
- Verify member subsidy, review policy for exchange reinstatements, adjust claims and Assist supervisor on adjusting any rappers that she routes to me.
- Enter record of inquiries and related correspondence in computerized tracking system.
- Research policy information and membership records to resolve issues.
- Compose both verbal and written responses to inquiries.
- Receives and responds to telephone, e-mail, written and walk-in inquiries from designated members, providers, attorneys, agents and third-party administrators.
- Record inquiries and related correspondence on computerized customer service tracking system.
- Composes verbal and written responses.
- Performs in-depth research and analysis of complicated claim and coverage problems.
- Makes corrections to claims as required in multiple systems (includes FACETS) and works with Membership services to correct eligibility issues.
Member Service Coordinator/Administrative/Customer Service/Billing/Quality Control
Ultimate Escapes Destination Club
01.2004 - 01.2010
- Worked with Membership database of 1200, Resolving variety of member concerns, issues and billing.
- (World-class clients, Doctor’s, Attorney’s, Stockbrokers, Producer s)
- Requested rebills to be sent for members.
- Securing reservations, Member Billing, planning assigned Member trips, developing an in-depth knowledge of assigned Destinations, discussed in detail with each member how each plan worked, developed personalized relationship with individually assigned membership base and conduct new member orientations to educate Members on Club value, policies, and service delivery, selling new memberships.
Group Travel Coordinator/Quality Control/ Administrative/Call Center/Customer Service
WorldTravel/BTI
01.2001 - 01.2005
- Answered phones in busy call center, made flight, hotel and car reservations for corporate travelers, for groups of 10 to 3000 on Sabre airline computer system, entered data into the system, maintained quality customer service, helped clients resolve no show bills with hotels, spoke with sales department at major hotel chains every day.
- Created/Prepared reports and spread sheets for supervisor.
Administrative Assistant/Medical Staff at North Kansas City Hospital/Insurance-follow-up
Pro-Staff
01.2001 - 12.2001
- Operated office equipment, entered information into system, Answered phones in a professional manner, Answered client/customers questions, Controlled Inventory, Explained to sales representatives working in the field how to manage their computer and run software.
Human Resources Assistant/Benefits/Administrative/Insurance-follow up/Customer Service
Dairy Farmers of America
01.2000 - 01.2001
- Worked with employees on phone and computer/email on Insurance, Benefits and Payroll questions.
- Updated excel and SAP computer system, updated and filed life insurance for present and past employees, Helped director with employee confidential projects.
- Worked on daily basis with Group employers to explain all insurance policies and questions.
Corporate Travel Coordinator/Quality Control/Customer Service/Call Center/Customer Service
Travel & Transport
01.1998 - 01.2000
- Answered phones in a professional manner in a busy call center, maintained order in a busy environment, booked airline, hotel and car reservations for corporate travelers on Apollo airline computer system, worked with airline discounted contracts, entered and updated customer information, suggested best flights and hotels for clients, and sales.
Patient Account Representative/Billing, Insurance/ Customer Service/Claims
Heartland Health Systems
01.1996 - 01.1998
- Arranged payments on past due accounts, collections.
- Sent member monthly statement and posted payments.
- Worked with large Membership data base and Resolved Membership issues, many variety of members, Doctor’s, and Attorney’s.
- Multi-tasking, follow- up with insurance company on payment, dealt with commercial/Medicaid and Medicare, set up patient insurance in computer system, call insurance company on patient eligibility and benefits, set up financial aid for patients, balanced daily cash drawer.
- Received daily bankruptcies and checked our accounts, Pre-registered patients for in patient and out patient surgery, Assisted patients with questions on their statements, insurance billing, Multi-tasking busy environment.
Education
Diploma -
Savannah High School
Savannah, Missouri01.1988
Nursing/Biology - undefined
Missouri Western State College
St. Joseph, Missouri01.1995
Comprehensive Theory/SystemOne Computer Training Certificate - undefined
Cotter School of Travel
St. Joseph, Missouri01.1991
Skills
- Customer Service
- Multi-Tasking
- Claims Adjustments
- Insurance Billing/Follow up
- Medical Terminology
- Time Management
- Enrollments
- Accounts payable/Rec
- Reconciliation
- Management
- Excel/Microsoft Office
- Self-Starter
- Billing
- Membership Sales
- Travel Reservations
- Collections
- Team Oriented
- Provider’s Office
- Microsoft Excel
- Healthcare industry
- Provider relations
- Managed care
- Data validation
- Teamwork and collaboration
- Time management
- Problem-solving
- Attention to detail
- Problem-solving abilities
- Multitasking
- Critical thinking
- Organizational skills
- Team collaboration
- Decision-making
- Task prioritization
- Self motivation
- Analytical thinking
- Goal setting
- Professionalism
Certification
- Life Accident and Health Insurance Producer, Sales License
- SQM World Class Certification, with Blue Cross
Languages
English
Native or Bilingual
Timeline
Provider Data Specialist
Blue Cross Blue Shield of Kansas City
04.2023 - Current
Member Services Billing and Eligibility
Blue Cross Blue Shield of Kansas City
01.2015 - 04.2023
Customer Service 2-10.1
Blue Cross and Blue Shield of Kansas City
10.2011 - 01.2015
Member Service Coordinator/Administrative/Customer Service/Billing/Quality Control
Ultimate Escapes Destination Club
01.2004 - 01.2010
Group Travel Coordinator/Quality Control/ Administrative/Call Center/Customer Service
WorldTravel/BTI
01.2001 - 01.2005
Administrative Assistant/Medical Staff at North Kansas City Hospital/Insurance-follow-up
Pro-Staff
01.2001 - 12.2001
Human Resources Assistant/Benefits/Administrative/Insurance-follow up/Customer Service
Dairy Farmers of America
01.2000 - 01.2001
Corporate Travel Coordinator/Quality Control/Customer Service/Call Center/Customer Service
Travel & Transport
01.1998 - 01.2000
Patient Account Representative/Billing, Insurance/ Customer Service/Claims
Heartland Health Systems
01.1996 - 01.1998
Nursing/Biology - undefined
Missouri Western State College
Comprehensive Theory/SystemOne Computer Training Certificate - undefined
Cotter School of Travel
Diploma -
Savannah High School
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