Summary
Overview
Work History
Education
Skills
Timeline
Generic

Debra Spinelli

Vacaville,CA

Summary

Accomplished Coordination of Benefits Rep at UnitedHealthcare .Demonstrated ability to enhance inter-insurance coordination, significantly improving claims processing efficiency. Renowned for exceptional attention to detail and a professional demeanor, contributing to team success and reliable service delivery.

Overview

17
17
years of professional experience

Work History

Coordination of Benefits Rep

UnitedHealthcare
12.2017 - Current
  • Verify members eligibility and benefit information to determine primary and secondary coverage for Medicaid Members
  • Process claims for multiple states to coordinate benefits across multiple insurance plans for members enrolled in Commercial and Medicare Plans
  • Verify insurance coverage and communicate with other insurance to ensure accurate coverage dates for payment process f
  • Documented detailed notes about verification of member with each interaction with representatives from other insurance
  • Maintain accurate and up-to-date records of claims processing activities
  • Resolved issues and inquiries from plan participants regarding healthcare coverage and benefits.
  • Observed strict procedures to maintain data and plan participant confidentiality.
  • Checked members benefits for accuracy using Change Instamed and CMS. Input all data into Facets.

Enrollment Specialist

United Healthcare and Military Veterans
04.2013 - 12.2017
  • United Healthcare & Military Veterans is now the contractor that administers the TRICARE program to provide assistance to customers and assist with questions regarding all aspects of the TRICARE program
  • Provide assistance to TRICARE beneficiaries and to MTF staff members in relation to beneficiaries and other administrative matters between the MTF and United Healthcare
  • Update Tricare beneficiaries address and Primary Care Managers upon arrival to the MTF. Make changes in CCM (Customer Support Manager) and in Webdoes (Deers Online Enrollment Systems)
  • Assist customers with eligibility, benefits, and enrollment
  • Take enrollment fees and payments, assign members to a primary care manager assist with referrals and authorization and also with claims
  • Provided support and guidance to members regarding benefits, claims and other related inquiries
  • Supported staff by providing assistance during peak registration periods

Tricare Service Representative

TriWest Healthcare Alliance
12.2007 - 03.2013
  • Provide assistance to walk-in customers and assist with questions regarding all aspects of the TRICARE program
  • Provide assistance to TRICARE beneficiaries and the MTF staff members in relation to beneficiaries and other administrative matters between the MTF and TriWest
  • Assist with enrollment transfers from within the West Region and other TRICARE regions
  • Update members address and Primary Care Manager upon transfer to Travis AFB making changes in TACC (Tricare Application for Customer Care) and in DOES (Deers Online Enrollment Systems)
  • Assign members to Primary Care Manager, assist with referrals, authorizations and claims
  • Assist with consult tracking by collecting reports received by mail, fax or within the MTF. Make outbound calls to local network providers and input data regarding consult tracking
  • Ensure that the beneficiaries understand the grievance and appeals process when dissatisfied with provider, service or care
  • Maintain a working relationship with the MTF staff, document each beneficiary contact in TACC

Education

No Degree - Medical Administrative Assistant

CSI Career College
Vacaville, CA
01-2007

High School Diploma -

Hogan Senior High
Vallejo, CA
06-1980

Skills

  • Microsoft office
  • Benefits administration
  • Attention to detail
  • Professional and mature
  • Team player
  • Dependable
  • Organized and professional

Timeline

Coordination of Benefits Rep

UnitedHealthcare
12.2017 - Current

Enrollment Specialist

United Healthcare and Military Veterans
04.2013 - 12.2017

Tricare Service Representative

TriWest Healthcare Alliance
12.2007 - 03.2013

No Degree - Medical Administrative Assistant

CSI Career College

High School Diploma -

Hogan Senior High
Debra Spinelli