Frankie Hollaway
Denver,CO
Summary
Over 20 years in the medical insurance business as a results-oriented, performance-focused supervisor, team leader, claims processor, and CSR. In search of a demanding professional position where I can apply my communication and leadership abilities to improve team performance, raise community awareness, and accomplish objectives.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Claims Supervisor
Colorado Department of Labor and Employment
Denver, CO
06.2023 - Current
- Supervising, developing, promoting, and maintaining the operation of the pregnancy and bonding unit.
- Supervising a team of 8 to 16 claims adjudicators, processing appeals claims, and communicating with claimants.
- Lead resource planning by hiring enrollment management staff and overseeing training for new and current employees, as needed.
- Maintain staff results by coaching and counseling employees, as well as planning, monitoring, and appraising job results.
- Manage professional team members, which includes performance management and hiring of the employees within the department.
- Participate in the hire of new team members by selecting, orienting, and being responsible for the training of new employees.
- Develop strategic performance plans to support the objectives of the FAMLI department.
- Interpret and implement program policies in alignment with organizational objectives and goals.
- Collaborate with various departments to ensure the success of the team.
- Research and resolve escalated complex employee issues by identifying the root cause and working with the appropriate party to resolve the issue in a timely manner.
- Collaborate with my team to manage benefits-related processes effectively.
Contact Representative (GS-7)
Department of Veteran Affairs
Denver, CO
06.2019 - Current
- Developing, examining, adjusting, and recommending settlement of claims
- Determining the status of claims for services and maintaining claims information in computerized databases.
- Professionally worked directly with clients via phone and in writing email; conducted telephone interviews, responded to inquiries, and provided advisement and information to customers with questions regarding health care services, medical insurance, and benefit claims.
- Worked directly with patient, beneficiary, providers, and collection agency to mitigate and resolve situations in which the patient has been placed in an adverse credit situation due to non-payment or untimeliness of payment of medical claims.
- Outlined the process for filing a health care claim for payment; eligibility requirements, waivers, forms and required documentation.
- Received, processed, and requested authorization of health care services, supplies, and benefits using computerized databases.
- Analyzes clinical patient data to identify trends, opportunities for improvement, implement improvement initiatives and measures results. Prepared and developed claims; provided advice and assistance to customers in obtaining evidence and supporting documents required to complete transactions. Researched and answered complex questions. Detailed payment methodologies used in adjudicating medical claims to resolve client questions.
- Determined status of claims for service. Developed, examined, adjusted, reconsidered, and recommended settlement of various types of claims. Advised, educated, and outlined the basis for payment decisions and reasons for disallowance. Reviewed claims for accuracy and quality. Examined claims for errors and initiated action to correct errors in accordance with current operational policies. Utilized extensive claims management experience and judgment to review/process claims when policies were vague or interpretation may be required. Reprocessed adjusted claims to ensure they were paid out correctly.
- Managed Claims Processor teams. Conducted thorough training for employees, on boarding, and implemented processes that increased efficiency and productivity.
Team Leader | Medical Claims Processor
Jacobson Solutions (Gateway/BCBS of NC)
Chicago, IL
11.2015 - 12.2017
- Supervising a team of 12 Medicaid, COB, UB Claim Processors and managing and processing health insurance claims.
- Controlled and directed overall planning and execution of resources, manpower.
- Assessed and accurately processed medical Medicare, Medicaid, Professional and UB92's facility claims in alignmentwith Explanation of Benefits.
- Responsible and accountable for provided up-to-date daily productivity reports to upper management.
- Identified and investigated potentially fraudulent claims with emphasis on quality and cost control.
- Reviewed, audited, analyzed, and reported on quality discrepancies, audits, analyzes and reports on quality discrepancies.
- Professionally worked directly with clients via phone and in writing email; conducted telephone interviews, responded to inquiries, and provided advisement and information to customers with questions regarding health care services, medical insurance, and benefit claims. Interfaced directly with client to resolve and mitigate non-payment issues.
- Processed 150 claims daily.
- Significantly reduced loss ratios through fair and prompt processing of claims and by implementing effective process improvements.
- Maintained quality assurance throughout all claims processing functions and ensured accurate report generation.
- Significantly decreased loss ratios by implementing improvement processes
Team Leader | Medical Claims Processor
Dell Healthcare Services | Kaiser Permanente
Round Rock, TX
07.2012 - 07.2015
- Controlling and directing the overall planning and execution of resources, manpower, and processing medical claims.
Provider Enrollment Specialist
Broadpath Healthcare Services/CAHAB/BCBS
Tucson, AZ
10.2010 - 04.2012
- Establishing and processing new provider/facilities applications and providing customer service.
Travel Medical Claims Auditor
Jacobson Solutions (AETNA/AMERIGROUP/BCBS OF SC)
Chicago, IL
10.2007 - 05.2010
- Investigating and researching medical claims, examining claims for errors, and providing customer service.
Education
Bachelor of Science - Biology
Claflin University
Orangeburg, SC01.1988
Master's in Management -
Colorado State University
ColoradoLong Island University
Brookville, NYSkills
- Comprehensive experience applying federal, state, and local laws regarding benefit programs
- Reviewing/processing complex claims
- Advocating for Veterans/beneficiaries within the claims process
- Reviewing adjudications and processing professional, facility, Medicare, Medicaid, and COB UB/HHCFA Claims
- Providing education and information regarding insurance issues, benefits, authorizations, and policy contract language
- Supervise a team of 8 to 16 claims adjudicators at once, with coaching, training, EQEP documentation and 1:1 meetings Answering queries from Tri C supervisors and other supervisors via shared chat
- Auditing claims with high attention to detail and accountability
- Computer proficiency, particularly in Word and Excel
- Knowledge of teaching concepts, principles, theories, and practices in social or behavioral science fields
- Conducting interviews with veterans and their family members to establish concerns/issues, develop goals and plans, and determine referral services/options
- Establishing and maintaining effective working relationships with veterans and their families
- Effective oral and written communication skills
Certification
Domestic Violence Training, 26, CASA Family Systems, Orangeburg, SC, June 2015
Colorado State Supervisor Certificate - November 2023
Expiration Date November 2025
Issued By Colorado Center for Organizational Effectiveness
Certified Leave Management Leave Specialist - March2024
Expiration Date March 2026
Issued By DMEC
Specializedexperience
- 15+ years of comprehensive experience applying federal, state, and local laws regarding benefit programs; reviewing/processing complex claims; and advocating for Veterans/beneficiaries within the claims process.
- Expert in reviewing adjudications and the processing of professional, facility, Medicare, Medicaid, and COB UB/HHCFA Claims.
- Provide education and information regarding insurance issues, benefits, authorizations and explain policy contract language. Facilitate practical resolutions for customers and providers complaints.
- Auditor: Skillfully evaluate accuracy of claims with high attention to detail and accountability.
- Computer proficient, with strength in Word and Excel. Quickly learn new operating systems.
- Knowledge of Teaching concepts, principles, theories, and practices relating to one or more of the social or behavioral science fields.
- Skill in conducting interviews with the veterans and their family members to establish the nature and extent of concerns/issues, aid in developing goals and plans, and determine appropriate referral services/options.
- Skill in establishing and maintaining effective working relationships using tact and diplomacy in interactions with the veterans and their families.
- Ability to communicate effectively both orally and in writing.
Timeline
Claims Supervisor
Colorado Department of Labor and Employment
06.2023 - Current
Contact Representative (GS-7)
Department of Veteran Affairs
06.2019 - Current
Team Leader | Medical Claims Processor
Jacobson Solutions (Gateway/BCBS of NC)
11.2015 - 12.2017
Team Leader | Medical Claims Processor
Dell Healthcare Services | Kaiser Permanente
07.2012 - 07.2015
Provider Enrollment Specialist
Broadpath Healthcare Services/CAHAB/BCBS
10.2010 - 04.2012
Travel Medical Claims Auditor
Jacobson Solutions (AETNA/AMERIGROUP/BCBS OF SC)
10.2007 - 05.2010
Bachelor of Science - Biology
Claflin University
Master's in Management -
Colorado State University
Long Island University
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