FELICIA COLLINS
Pooler,USA
Summary
Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
25
25
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 the National Database (NDB). Duties include adding new providers, completing contract rate renewals, changing provider/facility Tax ID and MPIN numbers, and terminating providers per Medica requests that are 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.
- Suggested SOP and guide updates to help improve Medica loading processes.
- Utilized Preference 2.0 to update special processing instructions (SPIs), and suggested improvements to improve the application
- Was instrumental in successfully completing the annual DRG Project prior to the 10/1/2023 and 10/01/2024 effective dates
- Exceeded production and quality metrics for contracts loaded
Associate Provider Installation Specialist
Optum Behavioral Health
09.2021 - 02.2023
- Accurately loaded new behavioral health 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, and SOP updates 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 providers
- Ensured the proper benefits were applied to each claim by using the appropriate processes and procedures and claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines and benefit plan documents/certificates
- Surpassed quality metrics set by UnitedHealthcare E&I of 99.5% of claims adjusted correctly per month
- Attended and completed virtual Corrected Claims training class for National and Global E&I claim groups
Claims Representative
UnitedHealth Group
08.2000 - 10.2019
- Provided expertise and general claims support, with responsibility for reviewing, researching, investigating, processing, and adjusting claims on the UNET platform.
- Was responsible for processing claims for members with Medicare and other insurance (COB) coverage
- Recruited and selected to work on the OPX project for the SAM edit team, to identify error trends and report findings to senior leadership.
- Recommended by senior leadership to assist with the OPX rework reduction project to decrease maximum frequency per day (09) denials.
- Received training and worked within the RX Claims system to support Optum RX.
Education
Certificate - Anatomy/Physiology, Patient Care & Contact
US Naval Hospital Corps School
Great Lakes, IL06.1989
Bachelor of Science - Organizational Leadership w/Healthcare Administration Concentration
Dalton State University
Dalton, GAAssociate of Science - Psychology
Georgia State University
Atlanta, GASkills
- NDB
- COSMOS
- CORE/NAVIGATOR
- ORS
- UNET
- CSP FACETS
- OHBS FACETS
- SALESFORCE
- EPUF
- CLAIM PROCESSING
- ADJUSTMENTS/OVERPAYMENTS
- doc360
- CDB
- ISET
- IBAAG
- WAND
- IDRS
- ORMS
- ICUE
- Preference/Pref 20
- COB, Medicare, Medicaid
- Microsoft Office
- Critical thinking
- Customer service
- Quality focused
- Adaptability
- Verbal and written communication
- Power BI dashboard
- Data analysis
Volunteer Experience
Volunteered with Camp Twin Lakes
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
Certificate - Anatomy/Physiology, Patient Care & Contact
US Naval Hospital Corps School
Bachelor of Science - Organizational Leadership w/Healthcare Administration Concentration
Dalton State University
Associate of Science - Psychology
Georgia State University
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