Freda Harper
Summary
Enthusiastic collaborator with extensive experience in identifying business needs, analyzing data, and recommending solutions to drive organizational growth. Dynamic communicator and creative thinker passionate about the member services industry. Dedicated to assisting providers and members with authorizations and claims while leading with integrity. Analytical problem solver and researcher committed to developing rapport and building partnerships with colleagues and leaders.
Overview
23
23
years of professional experience
Work History
Configuration Analyst II
ANTHEM / ELEVANCE HEALTH
Norfolk, VA
01.2015 - 04.2024
- Built Network agreements in Facets NetWorX, using Medical Agreement configurator, for facilities and providers and created test claims for expected results and accuracy
- Ran claims reports in ACCESS to ensure claims were processed promptly by assigning network agreements to provider records or agreement builds
- Audited 100+ contracts for facilities and providers daily for rates and fee schedules to determine pricing
- Researched state files for hospitals, Rural Health clinics, and federally qualified health clinics to verify rates and make updates when needed
- Reviewed and adjudicated 500+ claims daily with payment totaling over $20K+
Configuration Analyst I
AMERIGROUP CORPORATION
Virginia Beach, VA
01.2012 - 01.2015
- Assign pricing agreements for participating / non-participating provider records for claim processing
- Examined over 20+ provider contracts in Macess daily, assigning correct pricing according to the contract's rate sheet
- Analyzed claims for errors and made corrections, providing records for incorrect valuation
- Developed pricing agreements for non-participating rural and federally qualified health clinics
Senior Provider Information Specialist
Amerigroup Corporation
Virginia Beach, VA
01.2006 - 01.2012
- Built provider, facility, and group records based on the provider's credentialing application and delegated rosters
- Updated providers credentialing status once the credentialing process was completed
- Processed return mail, PCP assignments, provider terminations, capitation payments, correspondence and appeals, and quality reports
Provider Service Representative
AMERIGROUP CORPORATION
Virginia Beach, VA
01.2002 - 01.2006
- Provide telephonic assistance to members and providers
- Assist providers with claims inquiries, appeals, and authorizations
- Assist members and providers with eligibility status and benefits inquiries
- Verify the member's primary care physician
Member Service Representative
AMERIGROUP CORPORATION
Virginia Beach, VA
01.2001 - 01.2002
- Provide telephone assistance to members regarding benefits
- Assisted members with benefits inquiries and eligibility status
- Assisted members with PCP changes
- Upon request, mailed out provider directories, member identification cards, handbooks, and HIPPA forms
- Assisted members with Explanations of benefits and Explanation of Payments inquiries
Education
Bachelor of Science (BS) - Accounting
Norfolk State University
Norfolk, VASkills
- Compliance
- Medical Records
- Authorizations Claims
- Behavioral Support
- Ethical Practices Social
- Pricing
- Record Building
- Microsoft Access
- Microsoft Excel
- NetworX Systems
- Facets
- Macess
- JIRA
- ClearQuest
- PEGA
- Problem-solving aptitude
- Written Communication
- Time management abilities
- Adaptability
- Professionalism
- Analytical Thinking
- Decision-Making
- Adaptability and Flexibility
- Effective Communication
- Project Documentation
Degree
BS
Timeline
Configuration Analyst II
ANTHEM / ELEVANCE HEALTH
01.2015 - 04.2024
Configuration Analyst I
AMERIGROUP CORPORATION
01.2012 - 01.2015
Senior Provider Information Specialist
Amerigroup Corporation
01.2006 - 01.2012
Provider Service Representative
AMERIGROUP CORPORATION
01.2002 - 01.2006
Member Service Representative
AMERIGROUP CORPORATION
01.2001 - 01.2002
Bachelor of Science (BS) - Accounting
Norfolk State University