Milton Fayson
Laveen,AZ
Summary
Results-driven Claims Analyst with extensive experience at Centene Corporation, adept at resolving complex claims discrepancies and enhancing regulatory compliance for Medicare and Medicaid. Proficient in AMYSIS, CENPAS and HRP systems, I excel in communication and collaboration, consistently improving claims processing efficiency and accuracy.
Overview
11
11
years of professional experience
Work History
Claims Analyst II
Centene Corporation
01.2020 - Current
- Analyze and resolve complex claims discrepancies, denials, and appeals for Medicare and Medicaid patients.
- Received and completed escalated assignments.
- Processed claim submissions accurately using company-specific software systems.
- Assisted team members in troubleshooting complex claim scenarios and providing solutions.
- Analyzed claims data to identify discrepancies and resolve issues promptly.
Claims Analyst
AETNA
06.2014 - 01.2020
- Process and analyze Medicare, Marketplace, and Medicaid claims for accuracy, completeness, and compliance with payer and regulatory guidelines.
- Investigate and resolve claim discrepancies, denials, and appeals.
- Collaborated with internal teams to test and improve claims processing and performance during the development of the HRP Claims Processing System.
- Analyzed claims data to identify trends and compliance issues.
- Processed and adjudicated claims using AETNA's proprietary systems.
Education
Some College (No Degree) - Elementary Education
Florida A&M University
Tallahassee, FLSkills
- Claims systems: AMYSIS
- Claims systems: CENPAS
- Claims systems: HRP
- Regulatory compliance: Medicare
- Regulatory compliance: Medicaid
- Regulatory compliance: Marketplace
- Communication: excellent written and verbal communication skills
Accomplishments
- Maintained Production and Quality to meet or exceed standards.
- Promotion to Claims Analyst II.
References
References available upon request.
Timeline
Claims Analyst II
Centene Corporation
01.2020 - Current
Claims Analyst
AETNA
06.2014 - 01.2020
Some College (No Degree) - Elementary Education
Florida A&M University
Similar Profiles
SU CHASU CHA
Business Analyst I at Centene CorporationBusiness Analyst I at Centene Corporation
Leilani Ayers McMahanLeilani Ayers McMahan
Account Coordinator at Centene CorporationAccount Coordinator at Centene Corporation
Edgar SepulvedaEdgar Sepulveda
Manager of Intake Operations at Centene CorporationManager of Intake Operations at Centene Corporation
Winnie NyamapfumbaWinnie Nyamapfumba
Care Engagement Specialist at Centene CorporationCare Engagement Specialist at Centene Corporation
Alyssa CodnerAlyssa Codner
Family Caregiver at Family MembersFamily Caregiver at Family Members