Summary
Overview
Work History
Education
Skills
References
Timeline
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Naomi Henderson

Youngsville,LA

Summary

Healthcare eligibility representative with 4+ years of experience. Expertise in efficiently processing medical claims and verifying insurance coverage. Adept at navigating and ensuring compliance with diverse payer systems. Seeking opportunity to contribute dynamic administrative skills to a healthcare team.

Overview

6
6
years of professional experience

Work History

Enrollment Eligibility Representative

Highmark Health
Remote
06.2022 - 10.2023
  • Served as primary contact as it relates to all enrollment tasks for assigned book of business, which include multiple group customers; maintain satisfied customers by providing superior service and practice attention to detail in various responsibilities.
  • Followed departmental guidelines to manage and prioritize own workload daily for assigned group customers to meet customer demands; may require assistance from superiors in managing or prioritizing this workload.
  • Answered member, provider, and group customer phone calls; adhering to department expectations for answering calls and providing friendly customer service.
  • Followed established procedures to maintain enrollment data in applicable systems and databases based on customer request, electronic file, or internal reports; seek guidance from superiors (mentor, team-lead, supervisor) for non-standard enrollment inquiries.

Medical Claims Processor

Molina Healthcare
Remote
03.2020 - 06.2022
  • Reviewed medical claims for accuracy and completeness, verifying patient eligibility and coding.
  • Ensured compliance with insurance company policies and procedures related to the processing of claims.
  • Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
  • Processed a high volume of claims on a daily basis using established time frames.

Quality Assurance Analyst

B&B Fashions
Houma, LA
01.2018 - 01.2020
  • Analyzed customer service calls to identify areas of improvement and provide feedback to agents.
  • Monitored customer conversations for quality assurance purposes, ensuring that all policies were followed.
  • Maintained detailed records of call center performance and provided reports to management.
  • Assisted in developing and implementing call center procedures and protocols.

Education

Associate of Science - Medical Billing and Coding

Ultimate Medical Academy

High School Diploma -

University View Academy

Skills

  • Patient Medical Records Maintenance
  • Medical Billing Processing
  • Claims Processing
  • Prior Authorizations
  • Electronic Health Record Systems
  • Medical and Claim Terminology
  • HIPAA Compliance
  • Production and Quality Background
  • Computer Navigation Proficiency
  • Experience calculating and formulating billing amounts
  • Ability to keep all company sensitive documents secure
  • Proficient in claims management software and healthcare
    information systems
  • Strong knowledge of medical coding and billing processes (CPT, ICD-10, HCPCS)
  • Familiarity with insurance regulations and industry standards
  • Excellent analytical and problem-solving skills
  • Exceptional attention to detail and accuracy
  • Effective written and verbal communication abilities
  • Ability to prioritize tasks and meet deadlines in a remote work environment
  • Group Health Insurance Administration
  • Carrier Enrollment and Data Reconciliation
  • Ability to demonstrate patience, empathy and compassion
  • COBRA and PHI Compliance
  • Task-Oriented with Strong Organizational Skills
  • Ability to Multitask and Prioritize Workload
  • Skilled in Microsoft Excel, Google Sheets, CRM platforms, and other database management systems
  • Collaborative team member, experienced in working in a
    fast-paced, dynamic environment

References

References available upon request.

Timeline

Enrollment Eligibility Representative

Highmark Health
06.2022 - 10.2023

Medical Claims Processor

Molina Healthcare
03.2020 - 06.2022

Quality Assurance Analyst

B&B Fashions
01.2018 - 01.2020

Associate of Science - Medical Billing and Coding

Ultimate Medical Academy

High School Diploma -

University View Academy

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