Aynna M. Email & Phone Number

• Analyzing new configuration and changes to existing configurations to perform all Client and Claims administration based on product design and functionality and perform test validation as needed• Making online and ad-hoc configuration changes within Javelina and supporting systems• Performing unit and/or end user testing for new provider contracts, and software changes as necessary that affect claims adjudication and member/client funding functionality• Proactively identifying opportunities and recommending system solutions that increase automation, resolve system deficiencies, and enhance claims processing and reporting to meet and exceed business requirements.• Perform unit and/or end user testing for new provider contracts, and software changes as necessary that affect claim adjudication rules.• Interact and coordinate system changes and schedules as necessary with the Technical Systems Analysts.

Maintains effective diary management system to ensure that all claims are handled timely. Audits claims entry process for quality assurance. Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefitsKey Contributions:• Assist with open enrollment • Works effectively with management to assist on any special projects when needed

Tampa, Florida

Brandon, Fl

**An industry-leading third-party administrator of company healthcare plans**At Continental Benefits, I have held three professional positions with progressive responsibility. As Claims Supervisor, I helped escalate claims issues from Account Managers and Customer Service professionals, trained and instructed team members, and planned and created work schedules that met budgetary and workload requirements. As Customer Service Manager, I supervised and coordinated the activity of 24 Customer Service Associates, hired and trained team members, created training manuals, assigned daily tasks, and monitored telephone queues to ensure acceptable hold times. Among my key contributions, I…*Managed and oversaw the daily work of 20 Claims Specialists in role as Claims Supervisor, maintaining work queues below the three-day standard and providing feedback to employees to allow them to effectively achieve their targets.*Supported the creation of a successful Customer Service Department that provided exemplary service.

Tampa/St. Petersburg, Florida Area

**Providing clinically excellent outpatient physical rehabilitation services**At Cora Rehabilitation Clinic, I interviewed patients to complete documentation, medical histories, and insurance forms. I also scheduled and confirmed patient appointments, completed claims forms, created invoices, and verified insurance benefits. In addition, I supported administrative duties that included inventory management, vendor relations, cash flow reporting, and volumetric for all patient staff. Among my key contributions, I…*Directed the flow of communications among patients, vendors, general inquiries personnel, and therapy staff.*Helped create and maintain compliance manuals to ensure efficient and effective operations.

Tampa/St. Petersburg, Florida Area

**A professional employer organization and human resource outsourcing company that provides HR and payroll services**In this role, I designed, evaluated, modified, and communicated benefits policies to ensure accuracy, competitiveness, and compliance with legal requirements and individual company personnel policies. Among my key contributions, I…*Administered employee insurance, pension and savings plans, and Family Medical Leave Act components in coordination with insurance brokers and plan carriers.*Supported the integration of benefit programs following mergers and acquisitions, and served as a mediator and benefits subject matter expert between providers and employees.

Bachelor, Health Care Administration

Associates, Health Care Administration