Risha J. Greene
North Arlington
Summary
Dedicated professional with an extensive background in health insurance administration. Highly proficient, fast learner, detailed and adaptable with a proven history of assisting teams with finalizing tasks for optimum outcomes.
Overview
17
17
years of professional experience
2
2
years of post-secondary education
Work History
Overpayment Accounting Analyst
CVS Health
10.2018 - Current
- Researches and resolves overpaid claims to determine accuracy and compliance with medical contracts, policies and state legislations
- Audits system automated overpayment claims for accuracy
- Assists team members, both offshore and stateside with claim and project questions to ensure accuracy
- Supports in training team members on project assignments and directions
- Delegates offshore and stateside project assignments
- Finalizes and closes completed projects in system
- Manages multiple overpayment projects to ensure that they are completed within desired timeframes
- Identifies overpayment trends to serve as predictors for future actions
- Collaborates with team members in organizing payment project instructions to optimize best practice workflows
- Assists with robot detailed guides for system changes
- Serves as an end user tester for software enhancements for multiple applications
Claims Benefits Specialist
Aetna, Inc.
11.2007 - 10.2018
- Finalized 40 medical and hospital claims per day for Major League Baseball in accordance with MLB provider medical and hospital contracts, Aetna claim policies and state legislations
- Trained new team members on claim processes and policy clarifications
- Served as subject matter expert in claims processes to assist all team members
- Acted as a tester for new system releases during the alpha and beta stages for improving claim payment optimization
Education
Associate of Applied Science - Network Management
Devry University
North Brunswick, NJ 09.2001 - 09.2003
Skills
Analytical reasoning
Timeline
Overpayment Accounting Analyst
CVS Health
10.2018 - Current
Claims Benefits Specialist
Aetna, Inc.
11.2007 - 10.2018
Associate of Applied Science - Network Management
Devry University
09.2001 - 09.2003
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