MIKEISHA WILKS
Tampa,FL
Summary
Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
10
10
years of professional experience
Work History
SCA Provider Data Specialist
United Health Group
11.2019 - 06.2024
- Received data from various inbound sources
- Employ database systems and tools for entering and researching provider data.
- Recorded daily work production in Omega system
- Assessed data integrity by cross-checking system results for precision and pinpointed necessary modifications
- Verified data synchronization between provider databases and claim payment platforms
- Contributed to various ad hoc projects as assigned
- Consistently achieved target production, quality, and time utilization metrics
- Maintains up-to-date understanding of business strategies, rules, and procedures
- Conducted extensive database research to retrieve accurate and vital information.
- Implemented new procedures for gathering relevant documents from providers upon initial registration process.
- Utilized various databases and tools to validate provider information such as licenses, certifications.
- Reviewed provider data submissions to ensure accuracy and completeness of information.
- Ensured that all changes made to existing records were properly documented and reflected accurately in the system.
Claims Specialist 1
WellCare
05.2018 - 11.2019
- Processing holds on Medicare and Medicaid claims for the Hawaii business line.
- Efficiently reviewing and addressing appeals and disputes submitted by providers is crucial.
- Manually pricing claims in the event of system configuration limitations,Regenerating specific claims to elicit pricing functionality
- Generated claims manually in instances where the system failed to create them
- Provided assistance with claims projects and generated work around documents as required
- Contributed to the update of step action tables.
- Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
- Evaluated the validity of assigned claims by verifying that services are medically necessary according to established guidelines.
- Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
Customer Service Representative
Meritain Health
10.2016 - 04.2018
- Quoting benefits for members and providers involves both fully insured and self-funded products.
- Proficient in operating and troubleshooting DG systems
- Ensured accurate claim status verification
- Educated providers and members on claims processing
- Registered members and providers for online accounts
- Verified provider network status by aligning with assigned plans' networks
- Confirmed and changed payment information for Nation Care dental accounts as the 3rd party administrator
- Facilitated seamless communication by promptly sending requested information via email and fax to both providers and members.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Developed strong relationships with customers by providing personalized assistance and support.
Customer Service Representative
Quest Diagnostics
09.2014 - 10.2016
- Handling escalated calls transferred from new representatives
- Walking the floor to assist new employees with any questions they might have.
- Entered specimen recollects into Care360 system through data entry
- Assisted in the reception of lab results by providing support to providers and members
- Provided education to providers regarding test information, specimen collections, requirements, and clinical significance.
- Assisted with test add-ons by supporting providers.
- Conducted regular follow-up calls with customers after resolving their issues.
Customer Service Representative
Health Plan Solutions, Aerotek
01.2014 - 05.2014
- Handled high volume of incoming calls at a third-party verification center
- Assisted Coventry Insurance members with electronic and phone bill payments
- Assisted clients in a timely manner while adhering to HIPPA's guidelines
- Managed billing and notifications for Coventry members.
- Developed positive relationships with customers through friendly interactions.
- Informed customers about billing procedures, processed payments, and provided payment option setup assistance.
- Provided excellent customer service to resolve customer complaints in a timely manner.
Education
Diploma -
Wharton High School
06.2013
Skills
- Medicaid knowledge
- Report Generation
- HIPAA Compliance
- Microsoft Excel
- Data Validation
- Provider Relations
- Task Prioritization
- Reliability
- Code Review
- Professionalism
- Written Communication
- Teamwork and Collaboration
- Interpersonal Skills
- Relationship Building
- Problem-solving abilities
- Database structures
- Analytical Thinking
- Claims review
- Payments posting
- Medical terminology knowledge
- Regulatory Compliance
- Claim Amount Calculations
- Eligibility Determination
- Data Entry
- Customer Service
- Background in insurance
- Policy Review
- Coverage Determination
- Appointment Scheduling
- Multi-line phone proficiency
- Insurance precertification processes
- Accurate Documentation
- MS Office expertise
- Scheduling Software
- Outbound calls
- Insurance Verification
- Critical Thinking
- Goal attainment
- Adaptability and Flexibility
- Patient Education
References
References upon request
Languages
English
Professional
References
References available upon request.
Timeline
SCA Provider Data Specialist
United Health Group
11.2019 - 06.2024
Claims Specialist 1
WellCare
05.2018 - 11.2019
Customer Service Representative
Meritain Health
10.2016 - 04.2018
Customer Service Representative
Quest Diagnostics
09.2014 - 10.2016
Customer Service Representative
Health Plan Solutions, Aerotek
01.2014 - 05.2014
Diploma -
Wharton High School