John Bolden
Richwoods,MO
Summary
Results-oriented professional with 5 years of deep expertise in healthcare administration, including claims processing and appeals/grievances coordination. Proven ability to manage deadlines, collaborate effectively, and ensure accuracy in high-volume environments. Specialize in maintaining provider information ensuring accurate and timely data is available. Demonstrate strong analytical skills coupled with familiarity with medical billing and coding procedures. Known for improving operational efficiencies by streamlining provider maintenance processes.
Overview
27
27
years of professional experience
Work History
Provider Maintenance
Catalyst Solutions
Denver, Colorado
09.2024 - Current
- HPI Group – Provider/Facility maintenance on Javelina web based claims adjudication system
- Building connectors for providers/facilities and attaching to claims, verifying and adding networks/benefits to the connectors
Claims Analyst
Catalyst Solutions
Denver, Colorado
08.2024 - 09.2024
- Aetna - Claims adjudication system HealthEdge, Training Only
Appeals and Grievances Coordinator
Catalyst Solutions
Denver, Colorado
04.2021 - 07.2024
- Aids Healthcare Foundation - claims adjudication system Ram Technologies HealthSuite
- Managed all aspects of the appeals and grievances process, ensuring compliance with CMS guidelines and timelines
- Collaborated with the Medical Director to resolve complex appeals efficiently
- Drafted and issued acknowledgement letters to maintain clear communication with stakeholders
Claims Analyst
Catalyst Solutions
Denver, Colorado
06.2020 - 04.2021
- Processed claims accurately and efficiently on Ram Technologies HealthSuite claims adjudication system, for the Aids Healthcare Foundation
- Developed and implemented templates to improve team efficiency and tracking
- Handled manual data entry for claims received through various channels (mail, fax)
Driver/Salesman
Bluff City Beer
Herculaneum, Missouri
11.2003 - 07.2018
- Built and maintained strong relationships with clients across four counties (Jefferson, St.Francois, Washington, Iron)
- Achieved sales targets while ensuring optimal product restocking and delivery
- Performed a variety of tasks, including warehouse maintenance, point-of-sale installation, and computer troubleshooting
Merchandiser
Manpower
Festus, Missouri
04.2003 - 11.2003
- Company Overview: for Bluff City Beer
- Managed efficient product rotation and shelf stocking within retail stores
- Provided support to delivery drivers during peak seasons
- Contributed to warehouse operations
- For Bluff City Beer
Programmer
Transportation Data Systems
St Louis, Missouri
01.1998 - 03.2003
- Developed and implemented a comprehensive freight payment system
- Maintained and managed a secure SQL database
- Designed and built the company website
- Created a web-based database and reporting system to streamline data access
Education
Certification - Mechanical Design And Drafting
Jefferson College
Hillsboro, MO05-1986
High School Diploma -
DeSoto Senior High School
DeSoto, MO05-1984
Skills
- Trained on HealthSuite
- Trained on HealthEdge
- Trained on Javelina
- Proficient Microsoft Office Suite(Excel Formulas)
- Microsoft Teams/Phone/Email Etiquette
- Computer Literacy
- Medical Terminology
- Contract Interpreting
- HIPAA
Timeline
Provider Maintenance
Catalyst Solutions
09.2024 - Current
Claims Analyst
Catalyst Solutions
08.2024 - 09.2024
Appeals and Grievances Coordinator
Catalyst Solutions
04.2021 - 07.2024
Claims Analyst
Catalyst Solutions
06.2020 - 04.2021
Driver/Salesman
Bluff City Beer
11.2003 - 07.2018
Merchandiser
Manpower
04.2003 - 11.2003
Programmer
Transportation Data Systems
01.1998 - 03.2003
Certification - Mechanical Design And Drafting
Jefferson College
High School Diploma -
DeSoto Senior High School