Meticulous professional with 16 years of experience in policy design, customer care, accounts receivable, medical billing, and claims analysis. Proven ability to work independently, manage multiple priorities while delivering exceptional results.
Hi, I’m
Candice Offord
Vestavia Hills,AL
Summary
Overview
16
years of professional experience
Work History
Cotiviti
Policy Design Specialist
08.2021 - Current
Job overview
- Implement and update medical policies for clients, ensuring alignment with industry standards and client expectations
- Write and design client-requested policies, translating client expectations into configurations
- Manage projects, work orders, and queues to ensure completion of requests
- Analyze pre- and post-client claim data to ensure accurate claim editing and resolve policy configuration errors
- Performed life cycle cost analysis for top medical insurance companies systems.
- Reviewed documents for compliance with local and national code requirements.
- Provided review and guidance for project non-conformances and operations issues.
Aetna, A CVS Health
Claims Examiner
01.2021 - 08.2021
Job overview
- Review claims information including coding, rates, benefits, and eligibility
- Process claims for payment or denial
- Researched claims and incident information to deliver solutions and resolve problems.
- Consulted police and hospital records when needed.
- Finalized files for insurance claim payment release.
- Investigated and processed insurance claims for policyholders.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Corrected codes to properly classify claims.
Aetna, A CVS Health
Behavioral Health Customer Care
12.2019 - 01.2021
Job overview
- Addressed questions and resolved issues from members, providers, and plan sponsors
- Processed claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals
- Handled appeals and pre-authorizations not managed by Clinical Claim Management.
- Completed documentation for every incident and forwarded to correct personnel for review.
- Built and maintained positive staff relationships to promote teamwork and better serve clients.
- Recognized individuals under influence of drugs or alcohol and typical behaviors associated with each.
- Performed client intake procedures according to internal standards for new admissions.
- Identified behaviors that necessitated intervention and obtained assistance from qualified personnel to complete intervention.
- Communicated with clients to assess mental health needs and develop individualized treatment plans.
- Engaged with colleagues in treatment team meetings to promote positive patient treatment outcomes.
Kassouf Medical
Medical Billing Specialist
01.2018 - 03.2019
Job overview
- Implement and update medical policies for clients, ensuring alignment with industry standards and client expectations
- Write and design client-requested policies, translating client expectations into configurations
- Manage projects, work orders, and queues to ensure completion of requests
- Analyze pre- and post-client claim data to ensure accurate claim editing and resolve policy configuration errors.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Located errors and promptly refiled rejected claims.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Identified and resolved patient billing and payment issues.
- Collected payments and applied to patient accounts.
- Posted and adjusted payments from insurance companies.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Precisely evaluated and verified benefits and eligibility.
University Of Alabama At Birmingham Hospital
Medical Billing and Payment Processor
11.2009 - 12.2018
Job overview
- Implement and update medical policies for clients, ensuring alignment with industry standards and client expectations
- Write and design client-requested policies, translating client expectations into configurations
- Manage projects, work orders, and queues to ensure completion of requests.
- Developed and implemented strategies to improve collection processes and reduce overdue payments.
- Submitted cash and check deposits and generated cash receipts to record money received.
- Reconciled accounts receivable ledger to verify payments and resolve variances.
- Utilized Microsoft Excel, QuickBooks and Oracle software to manage invoices and payments.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Generated monthly accounts receivable reports to submit developments for management review.
- Recorded deposits, reconciled monthly bank accounts and tracked expenses.
- Posted payments and collections on regular basis.
Blue Cross Blue Shield Of Alabama
Claims Analyst
05.2007 - 10.2009
Job overview
- Examined claims forms and records to determine insurance coverage
- Transmitted claims for payment or further investigation
- Prepared investigation findings report
- Calculated claim amounts
- Applied insurance rating systems.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Researched claims and incident information to deliver solutions and resolve problems.
- Resolved complex, severe exposure claims using high service oriented file handling.
Education
Martin Luther King Jr HighDetroit
Diploma
06.2002
University Overview
Skills
- Skills & abilities
- Healthcare Administration
- Customer Service
- Microsoft Suites
- Project Management
- Claims, Revenue Cycle
- Communication
- Problem-solving
Timeline
Policy Design Specialist
Cotiviti
08.2021 - Current
Claims Examiner
Aetna, A CVS Health
01.2021 - 08.2021
Behavioral Health Customer Care
Aetna, A CVS Health
12.2019 - 01.2021
Medical Billing Specialist
Kassouf Medical
01.2018 - 03.2019
Medical Billing and Payment Processor
University Of Alabama At Birmingham Hospital
11.2009 - 12.2018
Claims Analyst
Blue Cross Blue Shield Of Alabama
05.2007 - 10.2009
Martin Luther King Jr High
Diploma
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