Levorica Allen
Membership Rep/Claim Examiner
Sneads,FL
Summary
Knowledgeable and dedicated customer service professional with extensive experience in 10 years industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Membership Services Representative
Elevance Health
01.2023 - 03.2024
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Passionate about learning and committed to continual improvement.
Claims Examiner
Sutherland-Healthfirst
05.2022 - 01.2023
- Processed medical claims thoroughly, on time, and effectively
- Required to reach production quality/quantity percentages daily
- Experienced with exact claim pricing requiring skills for math problems
- Experienced with APG guidelines
- Assisted claims adjusters to manage the volume of cases
- Provided expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims
- Responsible for processing complex medical and facility claims accurately
- Analyzed and processed transactions, with a strong understanding of Claims.
Medical Claims Processor & Customer Service Representative
Zotec Partners
07.2021 - 05.2022
- Answered phones, insurance writ-Off, insurance adjustments, allocated payments, and processed claims
- Handled inbound calls, gathered customer information, assessed, and fulfilled customer needs, and educated customers about products and services
- Responsible for matching paper insurance claim forms and appeals with the necessary documentation, generating collection files, and handling high-volume calls
- Conducted detailed claim reviews and answered incoming calls from clients, claimants, and physicians
- Effectively managed and prioritized a work queue and multiple job responsibilities in a fast-paced environment, frequently with aggressive deadlines
- Submitted medical claims to commercial insurance companies, Medicare, and Medicaid for payment using ICD-9 and CPT coding
- Reviewed and verified patient account information against insurance program specifications, and analyzed procedures and diagnoses using ICD-9 codes
- Submitted Medicare and Medicaid claims for payments.
Full-Time Student
Ultimate Medical Academy
07.2018 - 12.2019
- Remained self-directed, motivated, and accountable for personal actions
- Came prepared for class and completed assignments on time
- Navigated innovative technology, utilized available resources, and set realistic expectations.
Education
Bachelor-Healthcare Administration -
Strayer University
01.2023
Associate of Science Degree - Medical Billing and Coding -
Ultimate Medical Academy
01.2019
Diploma in Medical Billing and Coding -
UEI College
01.2010
Diploma in Medical Assistant -
UEI College
01.2010
Skills
- Payment Posting
- Scheduling
- HIPAA (Health Insurance Portability and Accountability) Compliance
- Insurance Verification
- Insurance Claim Processing
- EOBs (Explanation of Benefits)
- Co-Payments
- Deductibles
- Medical Billing
- CMS 1500
- Electronic Health Records (EHR)
- Managed Care (HMO (HEALTH MAINTENANCE ORGANIZATION), PPO (Preferred Provider Organization), POS (POINT OF SERVICE))
- Government Payers
- Third-Party Payers
- Workers' Compensation
- Medical Coding ICD-9
- ICD-10
- HCPCS (Healthcare Common Procedure Coding System)
- CPT (Current Procedural Terminology)
- Medical Terminology
- Medicare
- Medicaid
- Tricare
- Fee Schedules
- Electronic Medical Records (EMR)
- Requested Referrals
- Medical Office Procedures
- Call Center
- Customer Support
- Customer Service
- CSR (Chase Status Report) - Inbound Calls/Outbound Calls
- Medical Claims
- Data entry
- Computer literacy
- Negotiation
- Allscripts
- Patient Care
- Epic
- Anatomy Knowledge
- Triage
- Clerical Experience
- Medical Scheduling
- Vital Signs
- Experience Administering Injections
- Windows
- Analysis skills
- Multi-line phone systems
- Phone Etiquette
- Cerner
- Microsoft PowerPoint
- Accounting
- Physiology Knowledge
- Smartsheet
- Documentation review
- Audits
- Call Volume Analysis
- Call Control
- Membership Registrations
- Customer Inquiries
- Information Updates
- High-Volume Environments
- Customer Loyalty
- Team Goals
- Understanding Customer Needs
- Document and Records Management
- Call Volume and Quality Metrics
- Calm and Professional Under Pressure
- Membership Inquiries and Renewals
Certification
- CPR (Customary, Prevailing and Reasonable) Certification
- Certified Medical Assistant
- Medical Billing Certification
Employment Gaps
- She was taking care of her mother as she was not keeping well and had to provide complete care and, she was working in a part-time role like helping when the hurricane came but mostly looking after her mother., Dec 2019, May 2021
- Looking for potential job opportunities., Apr 2014, Jul 2014
- Attending school due to which there is a gap., Nov 2012, Jul 2013
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Membership Services Representative
Elevance Health
01.2023 - 03.2024
Claims Examiner
Sutherland-Healthfirst
05.2022 - 01.2023
Medical Claims Processor & Customer Service Representative
Zotec Partners
07.2021 - 05.2022
Full-Time Student
Ultimate Medical Academy
07.2018 - 12.2019
Bachelor-Healthcare Administration -
Strayer University
Associate of Science Degree - Medical Billing and Coding -
Ultimate Medical Academy
Diploma in Medical Billing and Coding -
UEI College
Diploma in Medical Assistant -
UEI College
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