Summary
Overview
Work History
Education
Skills
Timeline
Generic

Corsica Hoover

Nashville,TN

Summary

Results-driven professional with a proven track record in implementing positive change and managing multiple tasks efficiently. Strong time management and organizational skills contribute to team success. Seeking a Claims Analyst position to leverage expertise in claims processing and analysis.

Overview

18
18
years of professional experience

Work History

Appeals & Claims Analyst

CVS Health
Remote
07.2022 - 12.2024
  • Keyed 60 medical claims daily, ensuring accuracy and compliance with industry standards.
  • Processed and adjudicated claims according to Medicare, Medicaid, and private insurance policies.
  • Conducted thorough claim reviews to verify medical necessity, coding accuracy, and coverage eligibility.
  • Generated financial performance reports to support strategic decision-making processes.
  • Identified and resolved billing discrepancies to minimize claim denials.
  • Maintained accurate records of payments and denials for auditing purposes.
  • Developed monitoring processes for operational areas, including eligibility and authorization data.
  • Investigated fraudulent claims by gathering evidence from multiple sources.

Secretary Treasurer

Zion Faith Baptist Church
Gallatin, TN
09.2020 - 06.2022
  • Managed high call volume, handling 100 inbound and 50 outbound calls daily to ensure operational efficiency.
  • Developed financial models for presentations and projects to support strategic planning.
  • Analyzed statistical data to identify trends and formulate financial strategies for investments.
  • Monitored cash flow, debt payments, and bank balances to ensure accurate financial reporting.
  • Created budgets and strategic plans for daily operations, ensuring fiscal responsibility.

Intake /Claims Processor

My Nexus Inc
Remote
08.2018 - 08.2020
  • Reviewed and processed 50 to 60 claims daily, ensuring accuracy and compliance with insurance policies.
  • Verified patient eligibility, coverage limits, and coding accuracy through EDI systems.
  • Interpreted complex policy language to inform decisions on claim approvals or denials.
  • Investigated denied claims, resolved discrepancies, and facilitated appeals for maximum reimbursement.
  • Communicated with healthcare providers and insurance representatives to clarify claim details.
  • Identified potential fraud or billing errors, maintaining strict adherence to HIPAA regulations.
  • Processed claims for various medical services, ensuring timely reimbursements and accurate adjudication.
  • Trained new hires on claims processing procedures and insurance policy guidelines.

Chat Support Representative

Asurion
Nashville, TN
04.2016 - 07.2018
  • Worked remotely, resolving 80 to 100 tech support tickets daily for customers.
  • Monitored systems and input commands to troubleshoot issues across various platforms.
  • Collaborated with supervisors to address customer inquiries or technical issues in a timely manner.
  • Provided solutions to a wide range of technical issues for customers and end-users across different time zones.
  • Recorded and maintained detailed notes for each client interaction to ensure follow-up and resolution.
  • Followed up with clients to verify that services were restored and issues were resolved to their satisfaction.
  • Assisted customers in diagnosing issues and explained solutions in clear, non-technical terms.
  • Activated accounts for clients seeking new services, ensuring the process was completed efficiently.
  • Submitted 40 service tickets daily for equipment maintenance requests, ensuring all issues were addressed promptly.
  • Troubleshot malfunctions and diagnosed issues to service equipment quickly and fully.
  • Performed quality assurance checks on completed tickets to ensure accuracy of information provided to customers.
  • Followed established protocols for escalation of unresolved customer issues to appropriate personnel.
  • Identified opportunities for process improvements based on trends in customer feedback.
  • Documented all customer interactions and inquiries in the ticketing system accurately and completely.
  • Resolved customer complaints in a timely manner while maintaining a positive attitude.
  • Monitored chat queues for incoming requests from customers requiring assistance.
  • Participated in ongoing training sessions regarding new products and updates to existing ones.
  • Reported any potential problems or bugs encountered while providing support.
  • Utilized resources such as FAQs, help documents, user manuals and other reference materials when assisting customers.
  • Utilized job-related software to prepare change of address records and issue service discontinuance orders.
  • Ensured compliance with company policies and procedures when dealing with customers.
  • Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
  • Mentored junior team members and managed employee relationships.
  • Engaged in conversation with customers to understand needs, resolve issues and answer product questions.

Behavioral Health Specialist

Accredo Health Group
Nashville, TN
03.2012 - 04.2016
  • Scheduled specialty medications daily ensuring timely and accurate processing of prescriptions.
  • Evaluated patient services, including scheduling medications, verifying insurance (TRICARE) and keyed in 30 patient behavior assessments in Microsoft Excel (Macro).
  • Ensured all patient demographic, prescription, and insurance data was accurately entered into the company's systems.
  • Researched prior authorization requirements for prescriptions and assisted providers and patients in completing necessary documentation.
  • Ensured patient care was optimized by adhering to clinical platform assessments and ensuring timely prescription refills.
  • Acted as a liaison between patients, providers, and contracted delivery services to track and reroute shipments as necessary.
  • Worked closely with mail-order pharmacies to ensure prescriptions were fulfilled on time and accurately.
  • Ensured compliance with HIPAA regulations, safeguarding patient information and ensuring confidentiality.
  • Communicated new developments in the pharmaceutical industry to clinicians, helping them navigate new therapies.
  • Documented all patient, provider, and client interactions within the appropriate systems for record-keeping and reporting purposes.
  • Monitored client progress through regular assessments and documented changes in behavior or symptoms.
  • Maintained accurate records of client interactions, including documentation of progress notes, evaluations, diagnoses, treatments, referrals.
  • Maintained confidentiality and adhered to ethical standards in all interactions with patients and their families.
  • Utilized electronic health records (EHR) to document patient interactions, treatment plans, and outcomes.
  • Documented information for charts, progress reports, assessments and other paperwork within specific timeframes.
  • Prepared and maintained required treatment records and reports.
  • Referred patients or clients to community resources or specialists.
  • Assessed patients for risk of suicide attempts or harmful behavior toward others.

Documentation Specialist

Medical Necessities
Nashville, TN
05.2007 - 02.2012
  • Performed quality assurance checks on all documentation material before final publication.
  • Assisted in the development of online help systems using HTML, JavaScript, XML, and other web technologies.
  • Gathered customer feedback regarding current documentation materials and used it to make necessary improvements.
  • Proofread existing documents for errors in grammar, punctuation, spelling, syntax, formatting.
  • Conducted research to ensure accuracy of information in technical documents.
  • Identified trends and provided feedback to customers on compliant documentation requirements for services provided.
  • Promptly responded to requests for information while maintaining security.
  • Communicated to identify and meet documentation needs.
  • Distributed copies of documents to professionals.
  • Filed accurate weekly, monthly, quarterly regulatory paperwork and maintained organization to support smooth audit processes.
  • Assisted end users with resolving electronic content access issues while maintaining security standards.
  • Destroyed obsolete and outdated records using company-mandated procedures.

Education

Diploma -

Antioch High School

Skills

  • Medical claims processing
  • Edison
  • Inpatient care
  • Outpatient care
  • Acute care
  • Skilled Nursing Facility
  • Information management
  • Health information management
  • Writing Skills
  • Risk management
  • Process improvement
  • Microsoft Word
  • Microsoft outlook
  • Revenue cycle management
  • Quality improvement
  • Microsoft Excel
  • Computer Skills
  • Windows
  • Process management
  • System analysis
  • Information security
  • Conflict management
  • Peoplesoft
  • JavaScript
  • Pharmacy Technician
  • Linked and Learning
  • Insurance Verification
  • Reimbursement Analysis
  • Healthcare Administration
  • Financial reporting
  • Payer Contract Compliance
  • Medicaid regulations
  • Payments Tracking
  • Vendor Information Analyzing
  • Data Entry
  • Adjudication
  • Documentation skills
  • Availity
  • Med-IT
  • Epic
  • Fraud Detection & Compliance
  • NexGen
  • ACAS
  • HRP
  • MNG
  • HMO
  • Rightfax
  • Interqual
  • QNXT
  • ERA
  • EFT
  • Connect Center
  • Claim Connect
  • Emdeon
  • Web Connect
  • Jira
  • SQL
  • Talent management
  • Reading comprehension
  • Audit processes
  • Time management
  • Data analysis
  • CRM
  • Oracle
  • ICD-10
  • Clinical Documentation Improvement
  • Right fax
  • Prior Authorizations
  • PBM
  • CMS
  • EDI
  • Risk Adjustment Coding
  • Billing
  • ESD
  • RX Home
  • Pharmacy
  • Inpatient Documentation Specialist
  • Outpatient Documentation Specialist
  • Medicare&Medicaid
  • Utilization Management
  • Call volume analysis
  • Customer complaint resolution
  • HIPAA compliance
  • Medical coding
  • Quality management
  • Clerical support / Office Administrative support
  • Scheduling
  • Bookkeeping
  • Appointment setting
  • Team leadership
  • Training & development
  • Team building
  • Eligibility review
  • Recruitment
  • Service level agreements (SLAs)
  • Project staffing
  • Pre-employment assessments
  • Behavioral health
  • Contracting
  • Excel spreadsheets
  • Insurance knowledge

Timeline

Appeals & Claims Analyst

CVS Health
07.2022 - 12.2024

Secretary Treasurer

Zion Faith Baptist Church
09.2020 - 06.2022

Intake /Claims Processor

My Nexus Inc
08.2018 - 08.2020

Chat Support Representative

Asurion
04.2016 - 07.2018

Behavioral Health Specialist

Accredo Health Group
03.2012 - 04.2016

Documentation Specialist

Medical Necessities
05.2007 - 02.2012

Diploma -

Antioch High School

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Corsica Hoover