Marquise N 2343 presentation

Marquis
Salon De

CSME
Ms. W
Summ

se Nelson
evelopment
E 2343
Walker
mer 2019

Table of

Cover letter……...P. 1
Thank you letter…….P. 1
Resume…..P.2-P.3
Business Card…….P. 4
Salon Price List……….P. 5
IRS Packecket…...P.6-P.9

f Contents

MARQUISE B. NELSON

2707 Eastex Freeway Houston, Texas 77026
281.989.5843
[email protected]

It is with great excitement that I submit my resume for consideration to become a member of your
team by responding to any open positions your company may have available.
This resume will focus on objective, career highlights, and other areas pertinent to my qualifications.
However, it simply cannot show you the levels of competence, confidence, and pride in performance
that motivates me. I am sure I can portray these qualities to you during the course of a personal
interview in which we may discuss employment opportunities and a desired salary.
If such a meeting is agreeable to you, please contact me at the phone number, address, or email shown
above. In the interim, I thank you for your attention and considerations of this employment.

I look forward to your reply!
Sincerely,

Marquise B. Nelson

Experience

ALBANA HEALTHCARE (REVENUE RECOVERY SPECIALIST) 06 / 2015– CURRENT

• Responsible for following up on outstanding accounts receivable for all payers including self-
pay and resolving denials

• Handled all correspondence related to an insurance claim or patient account
• Contacts third party insurance carriers, patients and other facilities as needed to achieve

maximum payment on an account and identify issues or changes to achieve profitability
• Coordinates with departments and insurance companies to correct errors as necessary
• Identify if claims are processed in or out of network
• Review and understand Explanation of Benefits (EOBs)
• Contact insurance company and ask for reconsideration if claims are processed incorrectly
• Contact insurance company for authorization of high tech radiology services and outpatient

surgery
• Review and approve payment reductions for attorney settlements
• Verify Patient demographics and insurance benefits
• Submit appeals of claims with documentation
• Monitors, evaluates, and reviews all cost reporting in support of claims
• Identified accounts meeting ERISA appeal opportunities
• Identified accounts not paid in accordance with the appropriate state and federal guidelines,

rules, regulations and laws.
• Served as a patient advocate to ensure claims payment were processed and paid according to

individual Summary Plan Descriptions
• Responsible for following up on outstanding accounts receivable for all payers.

UNITED HEALTHCARE (CUSTOMER SERVICE REPIII) 11 / 2013 - 06 / 2015

• Answer incoming phone calls from customers and identify the type of assistance the customer
needs.

• Ask appropriate questions and listen actively to identify specific questions or issues while
documenting required information in computer systems.

• Review and research incoming healthcare claims from members and providers by navigating
multiple computer systems and platforms and verifies the data/information necessary for
processing.

• Ensure that the proper benefits are applied to each claim by using the appropriate processes and
procedures (e.g. claims processing policies and procedures, grievance procedures, state
mandates, CMS/Medicare guidelines, benefit plan documents/certificates)

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• Communicate and collaborate with members and providers to resolve issues, using clear,
simple language to ensure understanding.

• Meet the performance goals established for the position in the areas of: efficiency, accuracy,
quality, member satisfaction and attendance.

VICTORY HEALTHCARE (PATIENT ACCESS SPECIALIST) 07/ 2011 – 10/2013

• Responsible for the verification of each potential patient that could possibly be candidates for
surgery

• Accountable for coordination with patients to complete all clearance items stipulated by insurance
carriers as well as daily contact with insurance carriers regarding pending cases in review

• Possess general knowledge of insurance requirements specific to each insurance carrier
• Actively managed cases, prepared and facilitated appeals when necessary
• Posted payment reimbursements
• Educate potential patients at informative seminars regarding requested criterion by the insurance

carrier weekly at selected COE facilities
• Appointment scheduling, insurance verification and data entry of patient demographics
• Entered authorizations and referrals into the Managed Care Module for billing purposes
• Pre-certified and scheduled all out-patient and inpatient procedures

QUALIFICATIONS Customer Service ▪ Filing ▪ Inventory ▪ MS Office Suite
▪ Data Entry ▪ Shipping and Receiving ▪ Multi-line Phones ▪ Bookkeeping

▪

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