Helen Blackman
Philadelphia,PA
Summary
Resourceful Service Liaison experienced in healthcare industry with focus on enhancing productivity and reputation. Seeking remote position. Achieved high productivity and efficient task completion through strong medical insurance knowledge and customer service expertise. Focused on optimizing service delivery, client satisfaction, and team collaboration.
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
38
38
years of professional experience
Work History
Senior Service Liaison Volunteer
Senior Services
Philadelphia, Pa
03.2024 - 10.2026
- Handled large influx calls via remote
- Coordinated client inquiries to enhance access to senior care services and community support programs.
- Scheduled appointments to connect families, caregivers, and service providers for better support.
- Assist request for seniors' interactions with insurance drug claims
- Identified delays in authorization processes for denied drug claims and recommended actionable solutions.
Credentialing Specialist
Zycron Corp Take Care Health
01.2013 - 01.2015
- Handled all clinical new hire credentialing and recredentialing for employment.
- Review credentialing and re-credentialing applications for completeness.
- Enter data for all initial credentialing and recredentialing applications into credentialing database.
- Served as liaison with Advanced Providers Hiring Managers, Human Resources, and Talent Acquisition departments.
- Load and scan all documents into the credentialing shared drive.
- Liaised with advanced providers hiring managers, human resources, and talent acquisition departments to streamline credentialing processes.
- Conducted research on credentialing requirements for various providers in each state to ensure compliance.
- Perform primary source verification of all provider credentials via telephone, fax, and online systems within the verification time limit.
- Research credentials needed for each state for various providers.
- Query online databases for malpractice and sanction reports.
- Prepared and presented credentialing results in weekly committee meetings to ensure compliance with AAHHC hiring standards.
- Communicated clearly and effectively with providers to obtain sensitive credentialing and recredentialing documents for verification.
- Obtain provider performance reports for the credentialing and recredentialing process.
Government Programs Eligibility Specialist
IBC Family of Companies
01.1998 - 01.2012
- Resolution requires a high level of accuracy and precision to avoid the loss of premiums paid to IBC. Position entails 100% resolution of the daily Centers for Medicare and Medicaid Services (CMS) accretion summary report to ensure proper reimbursement. Other duties included.
- Processing enrollment, plan change and termination request via hard copy & Fax Senior.
- Served as dunning specialist, managing billing inquiries and collections. review all enrollment requests for previous non-payment of premiums. Compare findings with billing department. Provide the result of the outcome letter with the enrollee.
- Reviewed daily resolutions for monthly CMS enrollment failures and pending reports to ensure compliance and accuracy.
- Resolve Plan Benefit Package (PBP) and non-PBP validation queues.
- Process and complete plan decisions provided by the Appeals and Grievances Department.
- Analyze status difference reports to resolve CMS information.
- Analyzed status difference reports to resolve discrepancies in CMS information, ensuring data integrity.
- Communicate with the Social Security Administration.
Patient Registrar III
Thomas Jefferson Hospital
01.2000 - 01.2008
- Register patient demographic and insurance information in IDX, Jeff-Chart Radiology Information Systems
- Verified insurance, obtained referrals and precertification information, and collected documented payments to ensure smooth patient processing.
- Schedule and confirm patient appointments
- Verified coding queues for accurate CPT/ICD9 codes to maintain compliance and facilitate billing.
- Forward appropriate paperwork for billing.
Managed Care Assistant/Pre-Certification Specialist
IBC Family of Companies
Philadelphia, PA
01.1994 - 01.1998
- Authorize durable medical equipment (DME), lab and transportation services for homebound members.
- Trained new hires on policy and phone procedures, researched and resolved provider claim denials, and supplied authorizations for provider payments.
- Determine cosmetic and experimental procedures by accessing medical policies and forwarding pending cases to RN for review.
- Handled out of hours emergency calls via remote
IBC/Bill Direct Enrollment Specialists
IBC Family of Companies
01.1992 - 01.1994
- Handled internal and external calls regarding enrollment issues, ensuring timely resolution for subscribers.
- Resolved inquiries from group and non-group subscribers, enhancing customer satisfaction and retention.
- Processed group and non-group reinstatements and inter-plan transfer requests, Investigated and resolved cash issues resulting in adjustments or manual refunds.
- Resolved enrollment discrepancies to ensure accurate records. for CMM, Personal Choice and Security 65 using MSIQ and BDIQ.
- Answer internal and external calls in reference to enrollment issues.
Claims Examiner/ Benefits Specialist
IBC Family of Companies
01.1989 - 01.1992
- Maintained group benefit tables and processed benefit changes for existing accounts via queue and BDAF inquiries.
- Researched and resolved all suspended claims via electronic submission.
- Researched and resolved suspended claims through electronic submission, ensuring timely processing.
- Investigated improperly paid claims and performed adjustments.
Education
Bachelor of Science - Business Administration
Peirce College
Philadelphia, Pa 05.2001 -
Skills
- Computer laptop skills, Team Sharing, Microsoft , Word Excel Spreadsheet, Outlook, Legacy, Last Word, IDX, Medical terminology, ICD 10, CPT coding Nava Net, Care360, Oscar, Optimed, Diversity Skills SharePoint, UltiPro, NPDB, Verisys, Free Market Health Prime Therapeutics matching patients that require specialty medications
- Medicare enrollment process
- Credentialing verification
- Claims adjudication
- Authorization processes
- Insurance verification
- Prior authorization
- Credentialing database
Timeline
Senior Service Liaison Volunteer
Senior Services
03.2024 - 10.2026
Credentialing Specialist
Zycron Corp Take Care Health
01.2013 - 01.2015
Bachelor of Science - Business Administration
Peirce College
05.2001 -
Patient Registrar III
Thomas Jefferson Hospital
01.2000 - 01.2008
Government Programs Eligibility Specialist
IBC Family of Companies
01.1998 - 01.2012
Managed Care Assistant/Pre-Certification Specialist
IBC Family of Companies
01.1994 - 01.1998
IBC/Bill Direct Enrollment Specialists
IBC Family of Companies
01.1992 - 01.1994
Claims Examiner/ Benefits Specialist
IBC Family of Companies
01.1989 - 01.1992