CHERRON BARLOW
Customer Service
Southfield,MI
Summary
Extensive experience working in call centers and claims centers. Excel in high call volume and fast paced environments. Excellent ability to lead a team and work in a team based environment; contributing my problem solving, analytical, communication and customer service skills to accomplish goals.
Overview
20
20
years of professional experience
Work History
Claims Processor
JMS/Smart Data Solutions
2022.11 - Current
- Processed 16-25 HCFA/UB Medical Claims per hour on the Healthpac system
- Processed high dollar and specialty claims as requested
- Accurately entered claim data into system from provided images
- Performed other duties and projects as required by management
Disability Supervisor
Centauri Health Solutions Inc - Human Arc
2021.06 - 2022.07
- Implemented and monitored key performance indicators for staff.
- Compiled, reviewed and delivered weekly and monthly team reporting for KPM's and Audits.
- Reviewed and approved monthly disability awards and approvals.
- Entered monthly bonus and tier information for team members.
- Handled Supervisor calls from claimants to address concerns and barriers to service.
Claims Team Supervisor
Meridian Healthplan
2016.01 - 2021.06
- Led Medicaid and Commercial claims team to effectively and efficiently process claims at 35 claims per hour, take phone calls, address provider/member issues and concerns and keep a monthly quality of 96% plus
- Managed Team of 20 for Timesheets, PTO time, Scheduling and Claims Inquiries
- Responded to Network Development, IT, and Customer Experience departments on inquiries about claims issues and follow ups
- Worked collaboratively with other departments to maintain plan benefits, claim processing, MCS system management, and effective communication between departments and teams
- Monitored daily LAG report of received and held claims to ensure timely processing within 30 days
- Created and updated job aids and assisted with maintaining and updating of claims training manual
- Led weekly team huddles and meetings to deliver information, updates and guidelines on processing and benefits
- Attended weekly, bi-weekly and monthly meetings and calls with Providers and Network Specialists to review issue statuses and resolutions
- Assisted Management with other projects and tasks as assigned
Claims Examiner
Meridian Healthplan
2015.01 - 2016.01
- Processes medical claims for the Michigan Medicaid, Illinois Medicaid and Health Insurance Exchange Lines of Business in accordance with the plan benefits, authorization requirements, coordination of benefits, subrogation, and state insurance mandates
- Assisted Member Services, Care Coordination and other internal departments with questions from providers and members concerning claims
- Works collaboratively with Choice team members, leadership and other departments to resolve issues concerning claims payment for the Choice line of business
- Responds to email inquiries and requests as necessary
- Lead team engagement activities and provided information updates during huddles
- Performs other tasks as required by leadership
Medicare Member Benefit Coordinator
Meridian Healthplan
2014.04 - 2015.01
- Conducted inbound/outbound telephonic contact with members in a professional manner including OEV outreach, MMR outreach and Welcome Call/HRA completion
- Remained updated on all member and provider policy changes made by Meridian Healthplan or the State/CMS
- Responded to email requests and inquiries when necessary as well as Live Chat
- Maintained phone stats according to departmental goals and regulation standards
- Identified and submitted Grievances and Appeals and assisted in resolving the matters
- Lead team engagement activities during huddles
- Processed Enrollments for Prospective Medicare Members
Education
Early Childhood Education
Penn Foster College
Scottsdale, AZ2020
Professional Academy Healthcare Management-PAHM -
Academy Healthcare Management
2017
Certificate in Daycare Management: Childhood Education -
Penn Foster
Scranton, PA2012
Skills
- Supervising team
- Medicaid claims expertise
- Team leadership, training and development
- Working with teammates
- Claims processing documentation
- Claims and Call training, monitoring
Timeline
Claims Processor
JMS/Smart Data Solutions
2022.11 - Current
Disability Supervisor
Centauri Health Solutions Inc - Human Arc
2021.06 - 2022.07
Claims Team Supervisor
Meridian Healthplan
2016.01 - 2021.06
Claims Examiner
Meridian Healthplan
2015.01 - 2016.01
Medicare Member Benefit Coordinator
Meridian Healthplan
2014.04 - 2015.01
Early Childhood Education
Penn Foster College
Professional Academy Healthcare Management-PAHM -
Academy Healthcare Management
Certificate in Daycare Management: Childhood Education -
Penn Foster
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