Kyle Kusy
Manvel,TX
Summary
Efficient and detail-oriented professional with 15+ years of experience in benefits administration, provider relations, and claim resolution within the healthcare industry. Looking to transition into a new career path which puts me back in front of people where I can bring enthusiasm and my professional experiences together to be a valuable asset to any organization.
Overview
17
17
years of professional experience
Work History
Provider Relations Representative
Blue Cross and Blue Shield of Texas
Houston, TX
06.2023 - Current
- Developed and maintained positive relationships with healthcare providers, ensuring high levels of satisfaction and engagement
- Collaborated with internal teams to resolve provider issues and concerns in a timely manner, resulting in improved provider retention rates
- Managed a portfolio of 10 healthcare providers, effectively addressing their needs and promoting the value of our services
- Conducted regular meetings and trainings with providers to educate them on new products, services, and processes
- Collaborated with the credentialing team to ensure that all providers met regulatory requirements before joining the network
- Comfort in reading and explaining benefit plan designs for employees, as well as fee schedules, group contracts, and medical policy for contacts at assigned provider groups.
Time Off for Family Care
Houston, TX
03.2022 - 06.2023
- Relocated from suburban Philadelphia to Houston, TX for an employment opportunity for my spouse at the time.
- We decided it would be better for me to stay at home with our twin toddlers while we got acquainted with our new surroundings instead of paying for child care.
- Once kids were at an age we felt comfortable with, they were enrolled in a local day care and are now in elementary school.
Quality Business Analyst
Independence Blue Cross
Philadelphia, PA
04.2018 - 03.2022
- Responsible for auditing batches of medical claims from client groups to ensure accuracy of benefit design implementation, pricing, and accumulator amounts
- Demonstrated strict attention to detail by having to review complicated data and locate any irregularities
- Organized Microsoft Teams meetings for collaboration on issue resolution, weekly touch points, and monthly department meetings
- Responsible for training new employees and cross-training existing employees on claims audit process
- Implemented new process of sharing detailed error resolutions among audit team onto SharePoint site
- Comfort in navigating Medical Policy and can easily adapt to various claims or employee databases
Eligibility Specialist
AmeriHealth Administrators
Philadelphia, PA
01.2015 - 04.2018
- Audits weekly eligibility files from multiple electronic data interchange clients
- Received Top Performer rankings in last two yearly evaluations for both production and accuracy
- Integral part of data entry team responsible for migration of customer base into new proprietary platform
- Prompt resolution of items sent via multiple channels including direct emails from clients and call center
- Represents Eligibility department in dedicated customer service hub, providing timely resolution of urgent matters for company's highest priority client
- Routinely assists claims department with urgent matters requiring manual updates and rewriting eligibility history
Benefit Administrator
Benefit Harbor
Wayne, PA
09.2009 - 12.2014
- Resolved employee eligibility issues directly with various health, life insurance, and flexible spending account providers
- Processed monthly leave of absence (LOA) reports and made applicable changes to employee benefits based on client's LOA rules
- Researched and reconciled all issues appearing on carriers' weekly error files
- Worked with COBRA administrators to enroll/cancel COBRA coverage for employees
- Coordinated and participated in weekly phone conferences with internal team members and clients
COBRA Administrator
Armada Consulting Group
Lutherville-Timonium, MD
01.2011 - 07.2011
- Generated COBRA rights notices for new hires of all clients
- Managed 20-30 calls per day from potential and existing COBRA participants with their questions regarding payment and coverage
- Sent COBRA payment invoices to all participants, collected/processed their check payments, and updated coverage in ADP system
- Resolved employee eligibility issues directly with health and flexible spending account providers
Benefits Specialist
Willis of Pennsylvania
Radnor, PA
10.2008 - 09.2009
- Worked directly with administrators to resolve flexible spending account and benefit eligibility issues
- Explained features and benefits of various types of benefit options to employees of our clients
- Assisted 30-45 employees of various clients via telephone per day
Education
General Business
University of Houston-Downtown
Houston, TX05.2028
Skills
- Quality assurance
- Training
- EDI
- Strong written and interpersonal skills
- Benefits administration
- Customer service
- Comfort with all Microsoft Office applications as well as Teams and SharePoint
Timeline
Provider Relations Representative
Blue Cross and Blue Shield of Texas
06.2023 - Current
Time Off for Family Care
03.2022 - 06.2023
Quality Business Analyst
Independence Blue Cross
04.2018 - 03.2022
Eligibility Specialist
AmeriHealth Administrators
01.2015 - 04.2018
COBRA Administrator
Armada Consulting Group
01.2011 - 07.2011
Benefit Administrator
Benefit Harbor
09.2009 - 12.2014
Benefits Specialist
Willis of Pennsylvania
10.2008 - 09.2009
General Business
University of Houston-Downtown