MARY BENEFIELD
Healthcare Administrative
Cincinnati,Ohio
Summary
Excellent interpersonal skills and communication with all levels of management Strong performance to identify and interpret data and resolve exceptions and navigated multiple computer systems and platforms. Focused and results-oriented individual who can perform tasks in timely and efficient manner with minimal to no supervision. Critical thinker who can analyze situations and make decisions that support company goals and help to solve problems. Accurately executed daily processes and controls in a timely manner while ensuring company policies are followed. 1
Overview
10
10
years of professional experience
Work History
Cash/Claims Processor
Luxottica Group
02.2023 - 05.2023
- Ensure timely cash processing to outstanding invoices for medical claims
- Process revenue adjustments throughout the month for assigned operations
- Maintain accurate electronic files and evidence to support account reconciliations
- Follow-up on all major variances on a timely basis for the unapplied cash and cash transfers.
Claim Specialists
10.2021 - 04.2022
- Sedgwick Claims Services
- Conducts research and secures required information, including requesting member physician document for claims analysis,
- Maintains all documentation associated with the processing and resolution of complaints and grievances to comply with regulatory and client standard
- Response to Member inquiries via email telephone or notes on accounts
- Process members claims payment or denial request of payment timely and accurately.
Physician Scheduler
Bon Secours Mercy Health
02.2020 - 02.2021
- Primarily supports inquiries for: registration, general information, clinical connection and triaging patients to appropriate department
- Maintain processing timelines established through department service level targets
- Collaborates with medical staff and their associates to optimize efficiency and effectiveness in scheduling
- Responsible for verification and investigation of pre-certification, authorization, pre-determination and/or referral requirements for services
Financial Accounting Operations Specialist
Anthem Blue Cross
05.2018 - 11.2018
- Monitor and updates controls to ensure compliance
- Validate, record, and send checks, including expediting special handling
- Accurately execute daily processes and controls in a timely manner while ensuring company policies
- Processing customer and account source documents, reviewing data and detecting deficiencies.
Account Payable Data Entry Clerk
GE Global Operations
02.2018 - 04.2018
- Resolves complex issues with invoices and payments, investigate and resolve deficiencies with suppliers
- Accurately document information into systems capturing common issues to reduce reoccurring issues and inquires
- Process customer and account source documents, reviewing data and detecting deficiencies.
Claims Specialist
Anthem Blue Cross
03.2017 - 12.2017
- Update patient demographic and insurance information in the billing system and purging of duplicate claims
- Navigating multiple computer systems and platforms and verifies the data/information
- Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures
- Reviewing unresolved patient accounts to determine the appropriate action necessary to resolve open balance issues.
Document Validation Specialist
Duke Energy
05.2016 - 01.2017
- Compare data entered with source documents identifying errors and subsequently correcting any errors
- Perform verification/audit of data entry performed by other operators
- Communicate with Quality Assurance of problems or discrepancies encounter while entering and tabulating data from the various of documents
- Maintain the documents library as well as other databases.
Claims Analyst Representative
Anthem Blue Cross and Blue Shield
11.2015 - 01.2016
- Validate denial and corrective, duplicate claims in insurance software to ensure the accuracy of query results and that no refund has previously been posted in the system
- Communicate with management of any issues that would impede the accurate and timely review of claims
- Identifying changes with insurance company policies to ensure compliant billing and submitting of appeals in a timely manner.
Pharmacy Technician
CVS Pharmacy
08.2015 - 10.2015
- Assists pharmacists with pharmacy services and issues
- Process prescriptions, evaluates for quality and accurate patient identification and side labeling
- Receive high volume inbound call from patients with refill request and prescription questions
- Responsible for the identification and data entry of pharmacy prior authorization requests
Office Specialist
Robert Half Staffing Service
11.2014 - 01.2015
- Develop and maintaining the front reception area, answering high volume incoming calls of switchboard and directing calls to appropriate team members, greeting guests, registering visitors’ and delivering of messages and printing, scanning and filing of document
- Assisting in matching detail invoice information to payment information
- Input variety of data into computerized system and maintain files for correspondence records, and other documents assist in the preparation of a variety of financial implement organized filing systems.
Customer Service Specialist
Kroger Pharmacy Contact
09.2013 - 06.2014
- Center
- High volume inbound/outbound calls from patients to process new and existing refill prescription requests
- Respond to patient question and direct them to a pharmacist for clarification on issues concerning drug information and interaction
- Escalates requests to Pharmacist when request requires extensive
- Clinical review or denial
- Assist in streamlining communication with the patient, insurance claims verification, pharmacist and other healthcare-related parties.
Education
Cincinnati State Technical and Community College
Skills
- COMPUTER SKILLS
- Microsoft Office
- Recon Insurance Software
- EMR Software
- Salesforce Software
- ServiceNow Software
- SharePoint Software
- Microsoft Teams
- Outlook
- Medical Terminology
- Information Verification
- Verbal and Written Communication
- Policy Modifications and Updates
- Insurance Claim Forms Review
- Claim Amount Calculations
- Problem-Solving
- Eligibility Determination
- Payments Posting
- Claims Review
- New Policies Processing
- Critical Thinking
- Time Management
- Active Listening
- Payment and Investigation Escalations
- Attention to Detail
- Appointment Scheduling
- Microsoft Software Proficiency
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Timeline
Cash/Claims Processor
Luxottica Group
02.2023 - 05.2023
Claim Specialists
10.2021 - 04.2022
Physician Scheduler
Bon Secours Mercy Health
02.2020 - 02.2021
Financial Accounting Operations Specialist
Anthem Blue Cross
05.2018 - 11.2018
Account Payable Data Entry Clerk
GE Global Operations
02.2018 - 04.2018
Claims Specialist
Anthem Blue Cross
03.2017 - 12.2017
Document Validation Specialist
Duke Energy
05.2016 - 01.2017
Claims Analyst Representative
Anthem Blue Cross and Blue Shield
11.2015 - 01.2016
Pharmacy Technician
CVS Pharmacy
08.2015 - 10.2015
Office Specialist
Robert Half Staffing Service
11.2014 - 01.2015
Customer Service Specialist
Kroger Pharmacy Contact
09.2013 - 06.2014
Cincinnati State Technical and Community College