Summary
Overview
Work History
Education
Skills
Volunteer Experience
Timeline
Generic

FELICIA COLLINS

Pooler,GA

Summary

Skilled specialist with proven track record in delivering impactful results. Adept at team collaboration and flexible in adapting to changing needs. Expertise in managed care claims and contracts, consistently driving successful outcomes. Known for reliability and strong focus on achieving objectives.

Overview

24
24
years of professional experience

Work History

INSTALL SPECIALIST, PROVIDER DATA OPERATIONS

UNITED HEALTHCARE
02.2023 - Current
  • Effectively interpreted and loaded various Medica provider contracts into National Database (NDB), including adding new providers, completing contract renewals and provider/facility terminations received via the Core application
  • Managed multiple provider installation projects simultaneously, ensuring timely completion and delivering quality results
  • Provided training and support to new team members on best practices for managing a successful provider installation project
  • Assisted with SOP and Guide updates for Medica Loading processes
  • Completed the annual DRG Project prior to the 10/1/2023 and 10/01/2024 effective dates
  • Helped meet changing demands by recommending improvements to business systems or procedures.
  • Conducted regular reviews of operations and identified areas for improvement.
  • Collected, arranged, and input information into database system.

ASSOCIATE PROVIDER INSTALLATION SPECIALIST

OPTUM BEHAVIORAL HEALTH
09.2021 - 02.2023
  • Accurately loaded new contracts and amendments received via Salesforce into OHBS Facets and COSMOS and submitted to downstream reporting systems
  • Efficiently set up plan structure and billing, was responsible for interpreting various state provider contracts for loading into OHBS Facets database
  • Meticulously audited contract loads to ensure adherence to quality and reporting standards
  • Provided waste reduction recommendations on process improvements that the department utilizes to assist with contract loading

CLAIMS ADJUSTMENT REPRESENTATIVE

UnitedHealth GROUP
10.2019 - 09.2021
  • Responsible for executing necessary accounting adjustments in UNET for underpaid claims, by correcting them in the system and issuing additional funds to providers
  • Identified and completed overpayments by adjusting incorrectly processed claims, adding the overpayment into the ORMS overpayment system, and issuing letters requesting overpayment funds from the provider
  • Ensured the proper benefits were applied to each claim by using the appropriate processes and procedures (e.g
  • Claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
  • Surpassed quality metrics set by UnitedHealthcare E&I
  • Attended and completed virtual Corrected Claims training class for National and Global E&I claim groups

CLAIMS REPRESENTATIVE

UnitedHealth GROUP
08.2000 - 10.2019
  • Promoted to Representative to provide expertise and general claims support, with responsibility for reviewing, researching, investigating, processing, and adjusting claims on the UNET platform
  • Investigate and process claims for members with Medicare and other Insurance coverage
  • Selected out of 25 representatives to handle the high-profile TEXAS ERS Performance Guarantee account, acting as a primary claim processor and contact
  • Recruited to work on OPX project for SAM edit team, to identify error trends and report findings to Senior Leadership
  • Recommended by Senior Leadership to assist with OPX rework reduction project to decrease Maximum Frequency per day (09) denials
  • Received training and worked in the RX Claims system to support Optum RX

Education

Bachelor of Science - Organizational Leadership-Healthcare Administration

Dalton State University
Dalton, GA
12-2024

Associate of Science - Psychology

Georgia State University
05.2019

US Naval Hospital Corps School
Great Lakes, IL
05.1989

Skills

  • NDB
  • CORE/NAVIGATOR
  • UNET
  • CSP FACETS
  • OHBS FACETS
  • SALESFORCE
  • EPUF
  • COSMOS
  • CLAIM PROCESSING and ADJUSTMENTS
  • PEGA
  • ORMS
  • ORS
  • ECHO
  • DOC360
  • CDB
  • CES
  • IBAAG
  • IDRS
  • ISET
  • PREFERENCE
  • ICUE
  • Medicare
  • Medicaid
  • Coordination of Benefits (COB)
  • Project Management
  • Process Improvement
  • Microsoft Office
  • Data Entry
  • Customer Service
  • Detail Oriented
  • Self Motivation
  • Attention to Detail
  • Customer Relations
  • Quality Assurance
  • Adaptability and Flexibility
  • Issue Research
  • Written Communication

Volunteer Experience

  • Culture, Inclusion, and Diversity Team, 03/01/21, 09/01/21
  • Claim Operations and Benefits Installation Team

Timeline

INSTALL SPECIALIST, PROVIDER DATA OPERATIONS

UNITED HEALTHCARE
02.2023 - Current

ASSOCIATE PROVIDER INSTALLATION SPECIALIST

OPTUM BEHAVIORAL HEALTH
09.2021 - 02.2023

CLAIMS ADJUSTMENT REPRESENTATIVE

UnitedHealth GROUP
10.2019 - 09.2021

CLAIMS REPRESENTATIVE

UnitedHealth GROUP
08.2000 - 10.2019

Associate of Science - Psychology

Georgia State University

US Naval Hospital Corps School

Bachelor of Science - Organizational Leadership-Healthcare Administration

Dalton State University

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FELICIA COLLINS