George Gurney Email & Phone Number

Boston, Massachusetts, United States

• Daktronics LED scoreboard display programmer and operator for in-house live broadcast of Boston Celtics. Boston Bruins, Concerts, and Ice Shows
• Control Garden Digital Signage Network powered by Cisco's IP Video Distribution syste

Canton, Massachusetts, United States

• Processed medical claims for public plans, ensuring accuracy and adherence to plan guidelines.
• Reviewed and resolved complex claim issues, collaborating with healthcare providers and insurance companies.
• Utilized specialized software and systems to validate, adjudicate, and process medical claims efficiently.
• Maintained thorough documentation and records of claims processed, including correspondence and payment verification.

Canton, Massachusetts, United States

• Processed medical claims for public plans, ensuring accuracy and adherence to plan guidelines.
• Reviewed and resolved complex claim issues, collaborating with healthcare providers and insurance companies.
• Utilized specialized software and systems to validate, adjudicate, and process medical claims efficiently.
• Maintained thorough documentation and records of claims processed, including correspondence and payment verification.

• Accurately enter data into assigned case management databases
• Generate case management letters, as per department procedureSupport Regulatory and Accrediting Requirements:
• Facilitate timely interface with Network Medical Services to maintain the defined timeframes of the UM Review process
• Facilitate the maintenance of vendor program MA UM requirements
• Fulfill HIPAA requirements in both verbal and written communicationsSupport Timely Claims Payment:Complete MedHok Event documentation as defined by Massachusetts regulatory requirements
• Meet the department standard for resolution of THP service forms

Watertown, MA

• Accurately enter data into assigned case management databases
• Generate designated reports from case management databases within defined timeframes
• Generate case management letters, as per department procedure
• Review and distribute designated monthly reports for potential or new THP internal or external vendor program participants
• Serves as key contact for remote Case Managers for inquiries as they relate to internal THP programs and applications not readily accessible to the remote CM.Support Regulatory and Accrediting Requirements:
• Facilitate timely interface with Network Medical Services to maintain the defined timeframes of the UM Review process

• Defined Benefits training 2007Health and Benefits training 2008
• Provide a superior level of service support by responding to participant inquiries
• Process participant transaction requests in a timely and efficient manner
• Provide actionable data to various internal support groups as needed
• Identify, research, and resolve customer issues using company internal applications
• Follow-up on customer inquires not immediately resolved

• Processed requests for pre-registration of in-patient and out-patient procedures
• Verify member eligibility and initiate inquiries for difficult cases
• Resolve claims discrepancies through investigative research
• Developed training materials for Pre-Certification Department and tested system upgrades
• Cross-trained in various Tuft Health Plan products
• Maintained documents on company web page

• Travis Administrator
• Performed data management functions for a 24-hour customer service center
• Executed internal bank computer system database processing programs by troubleshooting system problems, controlled workflow management and maintained contact with senior management regarding system constraints Account.
• Processed monetary transfers, batching of teller work, Certificate of Deposit renewals, account reconciliation and Internet decryption
• Developed a mail merge database and served as a liaison between the management team and the operations department
• Trained in many areas of Account Management

Economics

High School Diploma