MEGHAN JOYCE
Cleveland
Summary
Detail-oriented insurance specialist with extensive experience in policy processing and proficiency in diverse insurance software. Recognized for exceptional analytical skills and the ability to interpret complex policies, ensuring effective resolution of claims to meet client expectations. Committed to maintaining accuracy in documentation and data entry, contributing to improved operational efficiency and customer satisfaction.
Overview
7
7
years of professional experience
Work History
Health Insurance - Associate Customer Care Specialist
Medical Mutual of Ohio
07.2023 - Current
- Proficiently navigates insurance systems, including Hummingbird TOPPS, Contact Online Reporting System, and National Network Hierarchy
- Conducts procedure code searches, ICD-10 coding, and analyzes diverse codes to ensure precision in medical billing accuracy
- Operates clinical systems such as Clinical System Lite and external pricing platforms
- Navigates through EOPS (Explanation of Payment System), CES portal, and OnBase to identify and compare discrepancies and accuracy in claim coding and provider services
- Utilizes NNS (National Network Search) for provider network management, coordination, and claim pricing
- Investigates out-of-state and Medicare crossover claims, ensuring compliance and accuracy throughout the process
Front Desk Receptionist
TRILOGY Gym & Spa
Cleveland
01.2020 - 12.2020
- Managed membership database using business management software (Mind body) and ensured accurate input of new and current members
- Responded to a multi-line phone system, directed calls to staff, and welcomed visitors to provide exceptional customer service
- Coordinated administrative duties, including responding to customer inquiries, generating daily reports, and managing email and messaging accounts
Dance Instructor
Cassidy Theatre
Cleveland
01.2018 - 12.2020
- Utilized a variety of teaching strategies to instruct students aged six through eighteen in the fundamentals, techniques, and proper positioning for different dance styles, resulting in successful learning outcomes
Education
Associate of Applied Science in Nursing (AAS) - Registered Nursing/Registered Nurse
Cuyahoga Community College
Cleveland, OH05-2027
Associate of Science - AS - Applied Sciences
Cuyahoga Community College
Cleveland, OH12.2020
General Studies -
Padua Franciscan High School
Parma, OH05.2018
Medical Terminology - Clinical Terminology for International and U.S. Students
The Univeristy of Pittsburgh
Skills
- Clinical Systems Coordination
- Network Provider Coordination
- Regulatory Adherence
- Proficient in Microsoft Office Suite
- Data Protection Knowledge
- HIPAA compliance and regulations
- ICD-10-cM coding
- Electronic health records (EHR)
- CPT Code Proficiency
- Insurance Eligibility Verification
- Efficient Claims Management
- Telephone etiquette
- Insurance regulations
Websites
Training
- DEI Foundations & Inclusive Language ILT Discussion
- Claims Research, Disbursements & Adjustments | Introduction to Medical Claim Forms
- Provider | Member Benefits & Eligibility - Medicare Advantage Provider Inquiries | Medicare Overview
- National Network System: National Network Hierarchy
- Health Plan Fraud Waste and Abuse | Security Basics - Data Handling and Security | Compliance Program Guidelines
- HIPAA General Awareness | Health Insurance Vocabulary
- OnBase Unity Client | PCL - The New Medical Policy Screen
Timeline
Health Insurance - Associate Customer Care Specialist
Medical Mutual of Ohio
07.2023 - Current
Front Desk Receptionist
TRILOGY Gym & Spa
01.2020 - 12.2020
Dance Instructor
Cassidy Theatre
01.2018 - 12.2020
Associate of Applied Science in Nursing (AAS) - Registered Nursing/Registered Nurse
Cuyahoga Community College
Associate of Science - AS - Applied Sciences
Cuyahoga Community College
General Studies -
Padua Franciscan High School
Medical Terminology - Clinical Terminology for International and U.S. Students
The Univeristy of Pittsburgh
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