Bonita A. Black
Temple Terrace,FL
Summary
Processed claims efficiently, demonstrating thirty-eight years of experience in the insurance industry. Supported customers by providing exceptional service and guidance in insurance-related inquiries. Utilized medical and insurance terminology effectively while enhancing communication and critical thinking skills.
Overview
20
20
years of professional experience
Work History
Provider Payment Reconsideration Analyst II
Elevance Health
2016.09 - Current
- Reviews, analyzes, and processes grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.
- Utilizes guidelines and review tools to conduct extensive research, analyze the grievance, and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
- Strictly follows department guidelines and tools to conduct reviews.
- Analyzes and renders determinations on assigned grievance and appeal issues and completion of the respective written communication documents to convey the determination.
- Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
- The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.
Disability Leave Analyst III
Amerigroup Insurance
2006.08 - 2016.09
- Managed leave of absence requests, ensuring compliance with company policies and regulations.
- Provided expert guidance to employees regarding benefits and entitlements during leaves of absence.
- Provided guidance on benefits eligibility, improving client understanding of available resources.
- Managed time efficiently in order to complete all tasks within deadlines.
- Organized and detail-oriented with a strong work ethic.
- Serve as primary contact for client by managing leave of absence administration as determined by client contract. Processes and administers all leave-of-absence requests and disability inform claimants of documentation required to process claims,
Education
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Bay Area Academy of Business
01.1989
High School Diploma -
Brandon Senior High School
Brandon, FL05.1986
Skills
ICD10 Codes
Dean Vaughn Medical Terminology
HIPPA
UB92 Forms
Customer Service
Medicaid Knowledge of state guidelines
Facets
WGS
Nextgen
Timeline
Provider Payment Reconsideration Analyst II
Elevance Health
2016.09 - Current
Disability Leave Analyst III
Amerigroup Insurance
2006.08 - 2016.09
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Bay Area Academy of Business
High School Diploma -
Brandon Senior High School