Summary
Overview
Work History
Education
Skills
Timeline
Manager
Kortoria Harrison

Kortoria Harrison

Tampa,FL

Summary

Results-oriented Analyst skillful in managing and breaking down large volumes of information. Proactive at heading off issues in operations, workflow and production by uncovering trends affecting business success. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

10
10
years of professional experience

Work History

Provider Data Management Analyst II

Centene
04.2019 - 12.2023
  • Validated results and performed quality assurance to assess accuracy of data
  • Performed system analysis, documentation, testing, implementation, and user support for platform transitions
  • Assessed data modeling and statistics to integrate high-level business processes with data rules
  • Performed audits of subsidiaries to protect shareholders and potential investors from fraudulent or unrepresentative financial claims
  • Maintained database systems to track and analyze operational data
  • Generated reports detailing findings and recommendations
  • Gathered, organized and input information into digital database
  • Cultivated relationships with industry leaders and within company to share tips and information.
  • Identified, analyzed and interpreted trends or patterns in complex data sets.

Claims Specialist II

WellCare
09.2016 - 04.2019
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations
  • Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures
  • Coordinated with contracting department to resolve payer issues
  • Paid or denied medical claims based upon established claims processing criteria
  • Maintained confidentiality of patient finances, records, and health statuses
  • Identified and resolved discrepancies between patient information and claims data
  • Researched and resolved complex medical claims issues to support timely processing.

Customer Care Representative

Anthem
06.2014 - 07.2016
  • Responded to customer and medical provider questions via telephone regarding insurance benefits, provider criteria, and eligibility
  • Logged call information and solutions provided into internal database
  • Responded to customer needs through competent customer service and prompt problem-solving
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction
  • Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions
  • Met customer call guidelines for service levels, handle time and productivity
  • Provided medical claims, appeals, and authorizations status
  • Knowledgeable of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, and healthcare terminology.

Education

Bachelor of Science - Psychology

Florida Agricultural And Mechanical University
Tallahassee, FL

Skills

  • Documentation And Reporting
  • Root Cause Analysis
  • Data Research and Validation
  • SQL and Databases
  • Payment and Investigation Escalations
  • Data Integrity
  • Healthcare Analytics
  • Business Analysis

Timeline

Provider Data Management Analyst II

Centene
04.2019 - 12.2023

Claims Specialist II

WellCare
09.2016 - 04.2019

Customer Care Representative

Anthem
06.2014 - 07.2016

Bachelor of Science - Psychology

Florida Agricultural And Mechanical University

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Kortoria Harrison