Demetrius Mapp
Center Line,MI
Summary
Highly adaptable healthcare administrative professional with over 15 years of experience in insurance and clinical support. Skilled in guiding personnel through organizational transitions and ensuring a 5-star member experience. Seeking opportunities to leverage expertise in a dynamic healthcare environment.
Overview
14
14
years of professional experience
Work History
Health & Wellness Engagement Assistant
Emerging Markets-Blue Cross Blue Shield of Michigan
08.2019 - Current
- Supports senior leadership in training and execution of Coordinated Care Programs and external vendor programs
- Provide regular performance reporting and feedback to guide future strategic direction and ideation
- Provide information and solve problems for team members, peers, management, and internal/external customers and participate in cross-functional teams as needed
- Assess staffing requirements and identify areas where team members need training and development
- Provide mentoring and support to help team members grow and perform their roles effectively
- Possess and maintain comprehensive knowledge of BCBSM's business, products, and programs to deliver exceptional member experience
- Acts as a liaison between corporate business areas and participates in group or committee discussions, such as Caregiver Strategy Group and Vendor and Care Management monthly meeting
- Maintain HCReferrals mailbox and process internal and external vendor referrals, such as Mom's Meals/GA Foods meal delivery forms, Landmark, and naviHealth, to appropriate Care Management programs.
A/R-Location Claims Resolution Support
Great Expressions Dental Center-PSC
08.2017 - 08.2018
- Worked closely with third-party vendors and insurance carriers to resolve any outstanding accounts
- Ensured accurate and timely claims processing for professional and institutional claims
- Provide location support and payment posting for offices in SE Michigan, Texas, New Jersey, and Atlanta
- Developed and maintained effective working relationships with all internal and external customers
- Collaborated with Patient Services team to resolve member disputes and facilitate communications to boost payment processes
- Played significant role in maintaining outstanding receivables at less than 10% beyond 60 days.
Dental and Vision Claims Representative
ADN Administrators
07.2015 - 09.2017
- Processed claim payments for orthodontic treatments quarterly for 42-60 groups
- Handled incoming calls from members and providers inquiring about claim status
- Adjudicated Prior Authorizations and Predeterminations for payment
- Participated in New Hire orientation which included procedure, expectations, and policies, along with specific training for that person’s role.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
Dental Specialist
Golnick Pediatric Dental and Associates
08.2010 - 04.2014
- Verified insurance for both surgical and non-surgical appointments.
- Verified payment posting to accounts via insurance pay, third-party, and patient copays.
- Greeted patients by name and updated addresses, telephone numbers, and insurance information as appropriate.
- Registered new patients and provide necessary forms (welcome letter, patient information, and office policy
- Called insurance companies and updated systems for all new patients and any changes.
- Scheduled appointments for both W
- Bloomfield and Taylor clinic locations
- Prepared patient charts in preparation for Electronic Medical Records (EMR) conversion while strictly following HIPAA regulations and ensuring patient confidentiality.
- Fostered welcoming environments for all patients, promoting trust in dental practice's services.
Education
Bachelor's Degree in Health Care -
University of Phoenix
Lansing, MIMedical Office Specialist -
KAPLAN CAREER INSTITUTE
Skills
- Positive Customer Engagement
- Initiative-Driven
- Computer Proficiency
- Collaborative
- Product Knowledge
- Interpersonal Skills
- Problem-Solving
- Time Management
- Adaptability
- Research Expertise
- Presentation Competency
- Active Listening
- Microsoft Office
- Microsoft Teams
- Excel
- Word
- CISCO
Websites
Timeline
Health & Wellness Engagement Assistant
Emerging Markets-Blue Cross Blue Shield of Michigan
08.2019 - Current
A/R-Location Claims Resolution Support
Great Expressions Dental Center-PSC
08.2017 - 08.2018
Dental and Vision Claims Representative
ADN Administrators
07.2015 - 09.2017
Dental Specialist
Golnick Pediatric Dental and Associates
08.2010 - 04.2014
Bachelor's Degree in Health Care -
University of Phoenix
Medical Office Specialist -
KAPLAN CAREER INSTITUTE