Selina Stevenson Campbell
Allentown,PA
Summary
Dynamic Claims Processor with extensive experience at 1199 SEIU National Benefit Fund, adept at resolving complex inquiries and enhancing service efficiency. Proficient in ICD-9 coding and medical documentation, demonstrating strong analytical skills and attention to detail. Successfully streamlined workflows, significantly reducing backlog and improving claims processing accuracy.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Short-Term Disability Case Manager III- Stat
Alight Solutions
Lincolnshire, IL
05.2024 - Current
- Resolved issues efficiently, showcasing strong problem-solving skills.
- Managed short-term disability claims during employee leave, ensuring accurate processing.
- Oversaw compliance with FMLA and Target Leave plans to meet regulatory standards.
- Administered provisions of Paid Family Leave and Pregnancy Fairness Workers Act.
- Organized tasks effectively to achieve timely completion of service goals.
- Collaborated with team members to meet project objectives and deadlines.
- Handled customer inquiries and requests to enhance overall satisfaction.
- Gathered medical documentation for clinical review processes, supporting efficient evaluations.
- Achieved high accuracy rate in daily production of completed reviews.
- Sustained up-to-date knowledge of CPT and ICD-10 coding principles, regulations, and billing requirements.
Short-Term Disability Case Manager III Non-Stat
Alight Solutions
Lincolnshire, IL
10.2019 - 05.2024
- Resolved issues efficiently, demonstrating strong problem-solving skills.
- Handled customer requests and inquiries to enhance satisfaction.
- Collaborated with team members to achieve project objectives and meet deadlines.
- Organized tasks effectively to ensure timely completion of service goals.
- Gathered medical documentation for clinical review processes.
- Managed claims for short-term disability during employee leave.
- Oversaw FMLA and Target Leave plans, ensuring compliance with regulations.
- Administered Paid Family Leave and Pregnancy Fairness Workers Act provisions.
- Achieved high accuracy rate in daily production of completed reviews.
- Sustained up-to-date knowledge of CPT and ICD-10 coding principles, regulations, and billing requirements.
- Use of MDGuidelines to determine the duration of leave required, as well as any other information needed to get clarification of the illness.
Disability Telephone Representative /Disability C, Telephone Representative /Disability Cs, Telephone Representative /Disability Cms, Telephone Representative /Disability Claims Examiner
1199 SEIU Nation Benefit Fund
New York, NY
03.2007 - 08.2018
- Resolved member inquiries regarding medical benefits and eligibility via phone support.
- Entered patient data from claims to ensure accurate processing and payment outcomes.
- Investigated workers' compensation claims by collaborating with members, providers, and employers.
- Adjusted claim payments based on relevant information and updated rate modifications.
- Generated wage verification letters while efficiently processing stop payment requests.
- Collected x-ray and medical notes for comprehensive evaluation of ongoing disability claims.
- Regularly updated knowledge base with detailed product and service insights.
- Documented order specifics, customer preferences, and billing information in the system.
- Helped the member understand their benefits and how they apply to disability as well.
- Determine eligibility for short-term disability.
- Transition into long-term disability.
Claims Processor
Metro Plus Health Plan/Claims processing
New York, NY
11.2005 - 08.2007
- Executed precise entry of hospital and medical data from billed claims into payment system, denials, or investigation
- Performed research on unpaid claims involving complex issues such as coordination of benefits, Medicare Secondary Payer rules.
- Achieved high accuracy rate in daily production of completed reviews.
- Sustained up-to-date knowledge of CPT and ICD-10 coding principles, regulations, and billing requirements.
Claims Processor
Promed Staffing
New York, NY
08.2005 - 09.2005
- Adjudicated claims for payment, denial, and investigation efficiently and accurately.
- Processed backlog of claims to update records to current processing date.
- Achieved high accuracy rate in daily production of completed reviews.
- Sustained up-to-date knowledge of CPT and ICD-10 coding principles, regulations, and billing requirements.
Claims Processor/ Customer Service
Amalgamated Life Insurance Co.
New York, NY
04.2001 - 06.2004
- Processed claims for EPO, POS, PPO health plans across multiple employer shops.
- Handled hospital and professional claims, including repricing for Beech Street discount.
- Streamlined workflow independently on various accounts to reduce backlog and enhance service.
- Achieved high accuracy rate in daily production of completed reviews.
- Sustained up-to-date knowledge of CPT and ICD-9 coding principles, regulations, and billing requirements.
Education
Associates degree - Health Administration
University of Phoenix
01.2010
Certificate - Medical Billing using Medical Manager Software
Kingsborough College
Certificate - Nurse Assistant
Travel Institute
Skills
- ICD-9 and CPT coding
- HCPCS and medical terminology
- Claims processing and billing
- Medical documentation
- Healthcare benefits administration
- Customer service and support
- Analytical thinking
- Attention to detail
- Conflict resolution
- Team collaboration
- Quick learning
- Data entry
- Leave administration
- Quality assurance
- Policy implementation
- Case management
References
Furnished Upon Request
Certification
- NYS Adjusters License Accident and Health
Languages
English
Professional
References
References available upon request.
Timeline
Short-Term Disability Case Manager III- Stat
Alight Solutions
05.2024 - Current
Short-Term Disability Case Manager III Non-Stat
Alight Solutions
10.2019 - 05.2024
Disability Telephone Representative /Disability C, Telephone Representative /Disability Cs, Telephone Representative /Disability Cms, Telephone Representative /Disability Claims Examiner
1199 SEIU Nation Benefit Fund
03.2007 - 08.2018
Claims Processor
Metro Plus Health Plan/Claims processing
11.2005 - 08.2007
Claims Processor
Promed Staffing
08.2005 - 09.2005
Claims Processor/ Customer Service
Amalgamated Life Insurance Co.
04.2001 - 06.2004
Associates degree - Health Administration
University of Phoenix
Certificate - Medical Billing using Medical Manager Software
Kingsborough College
Certificate - Nurse Assistant
Travel Institute
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