SERVICE ASSOCIATE III

Posted on: 2007-01-20

Joyl Lyntrelle Williams 1471 Dyal Street Jacksonville, FL 32206 Home: (904) 353-7601 Cell: (904) 386-7385 Email: [email protected] Objective: Seeking an opportunity to utilize my in-depth knowledge and extensive skills within a growing and upcoming organization. Professional Experience: 08/05-Present Homemaker 06/92-08/15/2005 Blue Cross and Blue Shield of Florida, Inc. 4800 Deerwood Campus Jacksonville, Florida 32246 06/92-08/05 Adjustment Analyst · Responsible for the netting of hospital billings · Processes previously adjudicated claims to ensure proper contract benefits are extended by method of Add-pay, Force-through, Reopen or Adjustment. · Serves as back-up Senior Examiner to provide technical assistance regarding the interpretation of guidelines. · Maintains outstanding quality and production to ensure team goals and standards are maintained. · Supports claims entry and suspense whenever needed. 01/89-06/92 Claims Service Representative III · Analyzed claims after adjudication for accuracy of processing by the system. · Utilized research skills to ensure medical policy guidelines and contract benefits were properly applied. · Maintained an understanding of BCBS products (PPO, POS, Traditional). · Identified system problems that would impact departmental and regional goals. · Cross-trained to handle incoming-phone calls as needed. 10/87-12/88 Claims Service Representative II · Researched pending claims to ensure proper adjudication. · Processed various types of claims in an accurate and timely manner. · Worked closely with various support areas such as Medical Review and Audit/Training. · Trained other examiners on the entry of UB-92 Claim forms. Education/Training: Edward Waters College Jacksonville, Florida Course of Studies: Business Administration · Wall of Fame Recipient · Most Valuable Player Awards · Zenger Miller Training · PBO Customer Service Training · Medical Terminology · TACT Training · PBO Entry Training · Medical Policy · G99 · PBO Reopen-Entry Training · Contract Benefits · PBO Adjustment Training · PBO Entry-Suspense Training · Phoenix Courses · Finance/Credits · Six Sigma - Yellow Belt Certified · Medicaid Liaison · Medicare Liaison · T.O.P. S. Award Recipient · Trainer · Group Champion References Available Upon Request