Motivational Team Leader skilled in designing and following production schedules. Offers proven history of maximizing team productivity to meet targets. Dedicated to employee safety and proactive assignment, schedule, and personnel management.
Overview
34
34
years of professional experience
Work History
Team Lead, Senior Claims Analyst
Blue Cross Blue Shield of Nebraska
03.2016 - Current
Demonstrates knowledge and proficiency on Inter-Plan Teleprocessing System (ITS), QNXT, Citrix Mainframe, Blue2 and Claim Administration claim systems, utilizing the Plan Connexion platform, Eligibility, HIPAA, Remittance Advice
Maintained LDLA quality standing for Blue Card claims
Complete Host audit and process on claims
Write-up root causes of on-going issues with Health Edge processing system
Answered Provider calls, handled questions and resolved any issues
Answer Plan-to-Plan calls to resolve any issues
Provide guidance, supervision, support and daily work load for staff
Wrote up system issues for IT department to remediate claims processing issues
Maintained quality assurance and assisted in ongoing training.
10.2019 - 02.2020
Responsible for creating test cases for institutional and professional claims to ensure code delivered from vendor was accurately adjudicating claims
Claims utilized the Plan Connexion system for BlueCard claims, and testing had to ensure all aspects of the system were working for Host and Home Plans using the Agile methodology
After implementation of the system, continued to test new upgrades and remediation of 'broken' code
Educational Assistant
Omaha Westside High School
09.2008 - 03.2016
Assist special education teacher in a classroom environment, and provide student instruction and support with educational goals.
Senior Patient Account Representative
Nebraska Methodist Health System
03.1998 - 09.2002
Provide customer service, direct patient contact for claims, account and insurance questions, audit patient accounts, educate patients on billing process, enter data, and update patient records.
Secondary Billing Representative
Nebraska Methodist Health System
01.1998 - 03.1998
Bill insurers, audit patient accounts, and maintain medical provider records.
Lead Underwriting Assistant
Equifax
06.1995 - 01.1998
Process and pre-underwrite health and life insurance coverage applications.
Administrative Assistant
J.L. Kizer & Associates
09.1990 - 06.1995
Assist sales associates with life insurance applications and perform general office administration duties.