S
Sierrea Whitetree
About
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Arizona, United States
Résumé
Jobs
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- BClaims AdjusterBanner Health-Oct 2020 - Current (6 years)-Performs detailed research and reprocessing of AHCCCS, Medicare (Special Needs Plan) and commercial claims using a back out function in IDX. The back out function takes the original claim and produces a replacement claim number. The claim is reprocessed on the replacement claims according to the nature of the request. -Reviews and reprocesses AHCCCS, Medicare, and Commercial Provider requests via Customer Care Service Requests. -Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues. -Serves as liaison with between departments such as Network Development, Medical Management, Finance and IS to research and rework projects submitted. -Reviews and reports all types of claims t
Claims ProcessorBanner HealthJan 2019 - Oct 2020 (1 year 10 months)- BClaims Processor (Temp)Banner Staffing ServicesJun 2018 - Dec 2018 (7 months)-Data-entry's' and adjudicates internal and external claims on a timely basis in accordance with departmental policies, procedures, and standards. -Research resubmitted or corrected claims and pends appropriately. -Adheres to governmental HIPPA guidelines for processing claims. -Refers to fee schedules, vendor contract, plan problems or concerns to manager or senior level processors for intervention. -Enters Siebel requests for provider updates, medical review, enrollment review, and coding review. -Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues. Process CMS 1500.
- CCustomer Service RepresentativeC3Jul 2017 - Apr 2018 (10 months)-Handle health insurance calls -Provide providers with benefits and eligibility on member plans -Review claim information and provide status, received, and finalized dates -Explain denial reasons -Submit claim adjustments -Stop and reissue checks sent out to providers if we have the wrong address -Check if any authorizations are required for the procedure codes given by providers -Review medical policies for different procedures and quote the website and where to find the information - Confirm providers participation with the insurance company -Follow Medicare guidelines -I follow HIPPA and KPI policies -Multi-task with two separate systems -Follow center performance guidelines -Meet compliance goals daily, weekly, and monthly -Knowledge of
- CSchedulerCODAC Behavioral Health Services inc.Apr 2016• Schedule patient appointments for therapists, new intakes, and medication refills - Request transportation
- HTellerHughes Federal Credit UnionApr 2016 - Mar 2017 (1 year)Provide account services to members such as -Receiving deposits and loan payments -Making withdrawals -Cashing checks and money orders -Printing cashier's checks, money orders or travelers' checks -Issuing gift cards -Open and close savings accounts
- Customer Service RepresentativeConvergysNov 2015 - Mar 2016 (5 months)• Assist patients with refilling their medications • Provide members with pick up times • Check inventory and pricing • I Handle a wide variety of inbound pharmacy calls • Review claim status and explain why it was denied and work through the steps such as placing Prior Authorizations or getting the pharmacy/physician the information, they need to fill the medications needed
- Customer Service RepresentativeCircle KApr 2015 - Oct 2016 (1 year 7 months)• Ring up customers and cash out in a timely manner • Handle counting cash and giving correct change • Dropping cash into the safe • Earning donations for charities • Clean entire store • Stock merchandise • Prepare coffee and hotdogs throughout shift • Log in new merchandise • Keep up on fuel prices • Take the trash and recycle
- ACustomer Service & Sales RepresentativeAfni Inc.Aug 2012 - Oct 2015 (3 years 3 months)• Build and maintain rapport with customers • Identify customer needs, review and update activity on accounts • Resolve customer issues in a prompt, professional and friendly manner • Provide Tier 1 technical support • Promote and sell products and services • Attend trainings to update product knowledge • Recommend new procedures to improve efficiency and effectiveness
- TCashierTaco Shop Co.Mar 2012 - Jun 2012 (4 months)• Receive payments via cash or credit cards and provide exact change • Greet customers • Maintain clean and orderly check out areas • Count out amounts in drawer • Provide balance sheets at the end of each shift
- TCaregiverTuty's DaycareJan 2012 - Aug 2012 (8 months)• Observe and monitor children from the ages of 6 months to 12 years of age • Keep records on individual children, including daily observations and information about activities, meals served, and medication administered • Administer snacks and nap time • Read to the children, and teach them simple handicrafts, painting, and songs • Sterilize toys and bottles and prepare formulas • Change diapers • Accompany children to and from school
- VVolunteerVictory Worship Center ChurchMay 2009 - Aug 2009 (4 months)• Clean and organize seats • Sorted through donated clothing and washed them
Education
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- CCPR CertificationJan 2012 - Jan 2014 (2 years 1 month)
- FFirst Aid CertificationJan 2012 - Jan 2014 (2 years 1 month)
- Some College creditPima Community CollegeJan 2012
- SHigh School DiplomaSouthern Arizona Community AcademyJan 2011