Othell Watkins
Peoria,AZ
Summary
Skilled in healthcare IT and claims customer service, I excel in fast-paced environments, as evidenced by my tenure at Maricopa County Human Resources. My analytical prowess and attention to detail have significantly improved claims processing accuracy. An adept communicator, I've mastered balancing multiple tasks, enhancing both efficiency and stakeholder satisfaction.
Overview
4
4
years of professional experience
Work History
Benefit Specialist
Maricopa County Human Resources
Phoenix, AZ
08.2024 - Current
- Provide excellent customer service to Maricopa County employees regarding all aspects of their Benefits and Wellness, including medical, pharmacy, behavioral health, dental, vision, short-term disability, life insurance, flexible spending accounts, health savings accounts, voluntary benefits, and wellness incentive
- Answer incoming phone calls in a phone intensive environment, respond to questions from employees, providers and vendors regarding the County’s benefits plans, including interpreting eligibility, plan documents, insurance carrier contracts, and coverage provisions
- Investigate and resolve employee concerns regarding benefits-related matters such as covered benefits, eligibility, cost, etc
- Utilize multiple software applications simultaneously, including vendors’ portals, and track all actions in the benefits case management and call recording systems
- Comply with regulatory, financial, tax and legal requirements for administering the Maricopa County benefits plans, including HIPAA privacy and security
- Participate in the annual Open Enrollment processes including planning events, answering questions, testing, and completing assigned variety of Open Enrollment tasks
- Verify that benefits premiums and administrative charges are being calculated and administered appropriately
- Write clear, concise benefits-related material using technical language, proper grammar, and correct punctuation, and tailor these communications to the targeted audience
- Complete Benefit Partner tasks as assigned in the Workday system
Revenue Recovery Specialist
Knowtion Health
Forney, TX
08.2023 - 07.2024
- Using the Artiva workflow management system, follow up on patient bills and claims to recover revenue from the responsible business entity. Depending on the department, the business entities may include any or all the following: commercial health insurance, governmental insurance, veteran’s benefits, third party administrators, attorneys, motor vehicle carriers, employers and worker’s compensation carriers
- Analyze information to identify root cause of denied or unpaid claim and determine next steps
- Pursue & obtain information needed to overturn claim denials, including patient & responsible party information, medical necessity, employer information, accident information
- Ensure appropriate timely filing guidelines are met for maximum reimbursement
- Escalate complex, complicated, or challenging accounts to management to ensure accounts are progressing effectively
- Identify and discuss root cause issues with management
- Consequence to errors in judgment are critical (HIPAA violation penalties, lost revenue for hospital client, other penalties, or fines)
Facets Medical Claims Processor
NTT Data
Forney, TX
07.2023 - 03.2024
- Process claims by following the policies and procedures as defined by the customer
- Take up additional trainings/new assignments or projects that may come up as per client needs
- Meet/Exceed required performance measures such as quality and productivity standards
- Meet/Exceed process SLA's
- Conform to the required regularity and compliance requirements such as HIPPA
- Conform to the organizational and client training requirements
- Understand how work impacts results for their area, as well as other processes.
- Demonstrate knowledge of internal operations and develops relationship to facilitate workflow
- Knowledge of related regulations and standards.
- Strong understanding of current process and procedures and may identify opportunity for improvement.
Rider Support Specialist
Cognizant Technologies Solutions
Scottsdale, AZ
12.2022 - 03.2023
- Monitor interactions through visual and audio prompts in our internal tools, using up to six monitors at a time while running as many as eight programs.
- Able to multi-task issues while moving from one program to another
- ring up issues that arise while troubleshooting to team leads
- Monitor user interactions and prioritize inquiries through our internal CRM system.
- Maintain up to date knowledge of self-driving technology
- Work in time-sensitive situations under pressure in a user-focused environment.
- Meet internal metrics such as quality, performance SLA's and shift adherence
Medical Claims Processor
Redirect Health
Scottsdale, AZ
05.2022 - 10.2022
- Processed Medical Claims, CMS 1500's / UB04's which included all provider specialties
- Review plan documents to ensure correct claim processing
- Ensuring that patient accumulators were applied to a particular benefit or professional services
- Verify patient and provider information alike to ensure eligibility throughout the entire claim
- Toggle between necessary data bases to verity patient information and demographics were current
- Respond to provider inquiries, claim status, via email, as well as making outbound calls to all interested stakeholders
- Participate in L10 department meetings and daily huddles.
Level II Claims Adjuster
Ask Staffing/Department of Economic Security
Phoenix, AZ
02.2021 - 03.2022
- Take inbound calls from Claimants effected by the pandemic resulting in unemployment, trying to obtain Pandemic Unemployment assistance.
- Perform core review on all claims for eligibility issues, payment issues, all issues within the scope in which to operate within a claim
- Provide excellent customer service by providing accurate and timely information to the claimant
- Review all pertinent information is on file, request additional documents and set issues as well as clearing issues on unemployment claims.
- Participate and active in all training requirements and meet all company and department metrics
Education
GED -
U.S. Army
Fort Lewis Washington04-1985
Some College (No Degree) -
Grand Canyon University
Phoenix, AZSkills
Experienced in a production environment in medical claims processing
Strong analytical and technical skills with the ability to maintain accuracy and production standards
Understanding of medical terminology with strong attention to detail and accuracy
Ability to multi-task, prioritize, problem-solve, and effectively adapt to a fast paced changing environment
Excellent written and oral communication skills
Critical thinking, technical skills, professionalism, and understanding with a wealth of pervious medical claims processing experience and plan knowledge
Healthcare IT/ Claims A/P, Provider contract configuration
Claims Customer Service
Unit Testing
Timeline
Benefit Specialist
Maricopa County Human Resources
08.2024 - Current
Revenue Recovery Specialist
Knowtion Health
08.2023 - 07.2024
Facets Medical Claims Processor
NTT Data
07.2023 - 03.2024
Rider Support Specialist
Cognizant Technologies Solutions
12.2022 - 03.2023
Medical Claims Processor
Redirect Health
05.2022 - 10.2022
Level II Claims Adjuster
Ask Staffing/Department of Economic Security
02.2021 - 03.2022
GED -
U.S. Army
Some College (No Degree) -
Grand Canyon University
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