Dynamic Senior Eligibility Specialist with extensive experience at Bluegrass Family Health, adept in data entry and effective communication. Successfully managed eligibility for over 250,000 insured, achieving a 90% service level. Proven track record in issue resolution and claims investigation, enhancing operational efficiency and team performance.
Performed follow up functions for denied, aged and worked target files
Execute telephone or email contact with payers
Access multiple payer websites for claim status, eligibility and benefits
Maintain current knowledge of payer specific requirements for billing, coding, claim resubmission, claim appeals and claim resolution
Completes assigned special projects
Maintain strictest confidenitality; adhere to all HIPAA guidelines and regulations
Perform and complete assigned projects other related duties as assigned
Provided daily operational responsibilities for the Commonwealth Services Unit.
Provided complete service to the employees and retirees of the Commonwealth of Kentucky along with the providers who service those members.
Supervised, trained, monitored and evaluated a staff of 40 customer service representatives.
Assured member and provider inquiries/complaints were answered in a timely and professional manner.
Managed the Eligibility for over 250,000 + insured
Maintained 90% service level while meeting call requirements for 9 consecutive years.
Standardized eligibility process which improved the timeliness of reviews.
Responsible for maintenance of member eligibility database, mailing of membership cards, welcome packets, Cobra and HIPAA notices. I interacted with other departments to resolve eligibility issues and billing discrepancies. Facilitated COBRA for state and commercial membership and cash posting. Processed refund requests for state agencies.