Megan McCarthy
Summary
Proven specialist with a track record of enhancing claim processing efficiency at Aetna, a CVS Health Company, by implementing best practices and identifying fraudulent claims, safeguarding financial assets. Skilled in data entry and Excel, coupled with exceptional attention to detail and teamwork, consistently delivering accurate benefits distribution and improving operational workflows.
Overview
8
8
years of professional experience
Work History
Claim Benefit Specialist
Aetna, A CVS Health Company
09.2018 - Current
- Manual medical data entry from one platform ( example : paper claims, electronic) to CVS claim processing data base
- Determine medical eligibility for members
- Review and adjudicate member claims based off of provider billing and member benefits
- Medical coding entry and review ( example: procedure codes, ICD-10 diagnosis codes provider TINs)
- Outbound calls to providers to attain missing/incorrect information such as required billing codes or billed charges
- Creating Excel spreadsheets of claims data daily ( example: documenting all claims paid, denied or touched on an hourly basis)
- High dollar claim payout review and release ( example : transplant relation, long term inpatient stays)
- Daily use of Microsoft outlook, TEAMS, Excel, Powerpoint and one note
- Identified fraudulent claims by thoroughly analyzing documentation, preventing financial losses for the company
- Facilitating TEAMS meetings on a circulating schedule ( example: on camera and share screen facilitating to team weekly metrics, goals and words of encouragement)
- Efficient communication with supervisor on outstanding production, pends, and issues
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices
- Collaborated with medical professionals for accurate assessment of disability claims, resulting in proper benefits distribution
Meat Cutter
Publix Grocery Store
03.2016 - 09.2018
- Cut meats to customer specifications and answered questions about specialty products.
- Followed all food safety regulations to maintain a safe work environment for both employees and customers.
- Maintained a clean and organized workspace for maximum productivity and safety.
- Cut, trimmed and ground meats such as beef, pork, and poultry to prepare for packaging and sale.
Education
High School Diploma -
Baldwin Middle-Senior Highschool
Jacksonville, FL06.2015
Skills
- Problem-Solving
- Attention to Detail
- Microsoft Outlook
- Excel
- Organization
- Customer Service
- Teamwork and Collaboration
- Data Entry
- Medical terminology
- Reliability
- Payment and Investigation Escalations
Accomplishments
At my time with CVS I was honored with the reward of, "Employee spotlight" where I was able to create a Power Point presentation about myself and present it to the claim benefits department. This opportunity was given to me as a reward for my hard work and ability to stand out amongst my peers. I was also rewarded, "employee of the month" twice while working with Publix. I take great honor in gaining these spotlights as I strive daily to be the best employee for my company, supervisors and team members.
Reference Contacts
- Mary Isaacs / McKesson Escalation Analyst (904) 844-1332
- Katelyn Sizemore / McKesson Sr. Customer Service Specialist (904) 652-5005
- Keri Dempsey / Mayo Clinic Registered Nurse (913) 223-9734
- Krista Bishop / Aetna Claim Benefit Specialist (904) 201-0232
Timeline
Claim Benefit Specialist
Aetna, A CVS Health Company
09.2018 - Current
Meat Cutter
Publix Grocery Store
03.2016 - 09.2018
High School Diploma -
Baldwin Middle-Senior Highschool
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