Priscilla Nguyen
Northglenn,CO
Summary
Rated Fully Successful in Program Administration, Organizational Goals and Customer Service.
Rated Exceptional in Team Work and Mission Support.
Overview
7
7
years of professional experience
Work History
Delivery Operations- Beneficiary Claims Processing Unit (BCPU)
Office of Integrated Veteran Care
Lakewood, CO
01.2020 - Current
- Major responsibilities include Creating and researching accounting records to verify cost data and availability of funds.
- Examines accounts and resolves difficult reconciliations requiring a detailed analysis of adjustments and corrective entries in the beneficiary’s account.
- Examines a full range of healthcare claims having a wide variety of complicating factors to include Other Health Insurance calculations and payment authorization documentation.
- Enters payment information into a computerized healthcare claims payment processing system which is applicable to the claim type and program type unless internal or external correspondence is required.
- Analyzes each claim submission to determine propriety of payment to include required certifications by authorized officials, compliance with contract provisions, price agreements, and/or other directive material.
- Performs ancillary preparatory components of Other Health Insurance resolution responsibilities, such as manually calculating and pro-rating proper distribution of OHI payments for specific dates of services on claims for accurate payment processing.
- Determines missing requirements and reconstructs incomplete files to allow completion of claim processing and letters to providers and beneficiaries.
- Kimberly McGee – Supervisor 303-587-6010
- Hours per week: 40
Specialized Experience- Delivery Operation
Office of Integrated Veteran Care
03.2022 - 03.2022
- Exercises some independent judgment establishing priorities to meet deadlines Participated in the Eligibility, Enrollment and Verification program (EEV)
- Entered Sponsor META DATA into DAPER Documents within the DAPER application.
- Successfully navigated DAPER locate incoming eligibility documents such as applications for CHAMPVA benefits.
- Worked closely with supervisors and team leads from Eligibility (EEV) to reduce backlog of documents.
- Input pertinent Veteran/ Sponsor information, document, and Update Idx.
- Tracked unreadable files and marked for supervisor action and further investigation.
- Volunteered to assist with CSC Correspondence.
- Used DAPER to research beneficiaries by SSN and reviewed all submitted correspondence for rejection codes and submitted eligible documents for processing.
Delivery Operations- Customer Experience, Contact Representative C4
Office of Community Care (OCC)
10.2018 - 01.2020
- Principal duties and responsibilities include supporting telephonic, written correspondence and live chat contacts.
- Advising, counseling, reviewing applications and claims/ and responding to requests regarding business processes for all associated health benefit programs which are administered by the CBOPC
- Assisting veterans and providers in developing needed documents and evidence required, or in resolving errors, delays, or other problems in obtaining benefits.
- Knowledge of medical terminology, proprietary claim adjudication software, cost, and payment methodologies
- Works directly with veterans, beneficiaries, providers, and collection agencies in an effort to mitigate or resolve situations in which the veteran or beneficiaries have been placed in adverse credit situations.
- Examines routine claims for errors and initiates actions to correct such errors in accordance with current operational policies and procedures.
- Health Net Spreadsheet- Coordinating the preparation, presentation, and communication of work-related information to the supervisor, working closely with other Customer Service Representatives, Supervisors and Senior Management.
- Knowledgeable concerning Health Net Financial Services claims.
- Christina Sudds-Gatlin – Supervisor You may contact my supervisor 720-480-5533
Education
High School Diploma -
Northglenn High School
Northglenn, CO05.2011
Skills
- Medical terminology interpretation
- Analytical reasoning
- Critical thinking
- Technical competence
- Organizational skills
- Multitasking
- Prioritization
- Reliability
- Punctuality
- Flexibility
- Communication skills
- Teamwork
- Customer service
- Attention to detail
- Accuracy
- Microsoft Word
- Microsoft Excel
- VISTA
- Citrix
- CXM Claims processing
- CHAMPVA
- DATANET
- Research
- DCN's
- DAPPER
- STELLENT
- CSC
- BPS
- United Service Desk
- CRM
- Knowledge Management
- KM
- BarCodeUtility
- PDI Live
- Re-Opens
- Unprocessed PDI's
- CSC Correspondence
- Conducts thorough research and problem solving
- Consults with leads and supervisors
Current Position
CLAIMS EXAMINER, GS-07 STEP 4
Personal Information
Title: CLAIMS EXAMINER
Timeline
Specialized Experience- Delivery Operation
Office of Integrated Veteran Care
03.2022 - 03.2022
Delivery Operations- Beneficiary Claims Processing Unit (BCPU)
Office of Integrated Veteran Care
01.2020 - Current
Delivery Operations- Customer Experience, Contact Representative C4
Office of Community Care (OCC)
10.2018 - 01.2020
High School Diploma -
Northglenn High School