Capricia D. Moore
Newport News,VA
Summary
Accomplished professional with a solid foundation in billing and coding administration in diverse healthcare settings. Proficient in key accounting duties related to insurance transactions and claims management. Demonstrated expertise in anatomy, physiology, medical terminology, and utilizing CPT and ICD-10 codes for diagnostic and procedural coding. Skilled in managing correspondence, processing mail, and overseeing general office operations.
Overview
13
13
years of professional experience
Work History
GBD Ops Anslyst
Elevance Health
01.2023 - 06.2025
- Worked with diverse teams to optimize project processes.
- Assessed potential risks to evaluate consequences on project deadlines and results.
- Addressed and resolved claims-related complaints from regulatory bodies.
- Facilitated resolution of escalated health plan conflicts.
- Executed comprehensive reviews of various dispute results.
- Handled intricate system challenges.
- Directed modifications of state settings.
Provider Payment Appeal Analyst I, GBD PI Collections, Disputes
Anthem
01.2023 - 06.2025
- Facilitates Payment Dispute process for all business lines, ensuring efficient resolution.
- Conducted evaluations of provider submissions to determine Reconsideration results.
- Adhered strictly to internal guidelines, policies, and procedures to determine appropriate resolutions.
- Engaged with multiple departments to develop effective resolutions.
Provider Payment Appeal Analyst I
Anthem
02.2021 - 05.2022
- Handles resolution of Provider Payment Reconsideration requests.
- Investigated claim payment or denial outcomes based on provider requests.
- Followed internal guidelines rigorously to establish appropriate resolutions.
- Collaborated with multiple departments to identify root causes and implement solutions.
Provider Pay Reconsideration Analyst I
Anthem
09.2019 - 02.2021
- Analyzes and determines outcomes for provider reconsideration cases.
- Utilized review tools and guidelines to perform in-depth research on grievance issues tied to claim events.
- Resolved processing errors while ensuring compliance with company policies.
- Undertakes extra assignments as directed.
Claims Analyst III - GBD Claims Department ITS
Anthem
06.2012 - 09.2019
- Conducts thorough reviews of intermediate and complex claim transactions.
- Interpreted and applied product contracts and fee schedules with precision for designated markets.
- Verified accuracy of payments and denials by corresponding with Host Plan.
- Ensured compliance with procedures and guidelines while correcting errors.
- Consistently meets and exceeds quality, production, and financial accuracy goals.
Education
Medical Insurance Billing and Coding Diploma -
Everest College
Chesapeake, VA07.2007
Skills
- PEGA NextGen 72
- Macess
- Facets (including ITS and Central)
- Blue Squared, Claims Admin, Filenet, BPM
- CCERT, ACMP-GBD
- PEGA Interact
Timeline
GBD Ops Anslyst
Elevance Health
01.2023 - 06.2025
Provider Payment Appeal Analyst I, GBD PI Collections, Disputes
Anthem
01.2023 - 06.2025
Provider Payment Appeal Analyst I
Anthem
02.2021 - 05.2022
Provider Pay Reconsideration Analyst I
Anthem
09.2019 - 02.2021
Claims Analyst III - GBD Claims Department ITS
Anthem
06.2012 - 09.2019
Medical Insurance Billing and Coding Diploma -
Everest College
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