Aleece Macklin Email & Phone Number

Owings Mills, Maryland, United States

• Reviewed provider coding information to report services and verify correctness by navigating multiple computer systems and platforms.• Prepared insurance claim forms or related documents and reviewed for completeness.• Maintained confidentiality of patient finances, records and health statuses.• Coordinated with contracting department to resolve payer issues.• Used administrative guidelines as resource or to answer questions when processing medical claims. • Evaluated accuracy and quality of data entered into agency management system.• Claim adjudication of specialty claims, including but not limited to, dental, therapy, pharmacy, ambulatory surgery, skilled nursing, duplicate claims, anesthesia, medical assistance, reprocessed claims, in/outpatient hospital, durable medical equipment & home healthcare. • Followed up on potentially fraudulent claims initiated by claims representatives.• Researched to respond to inquiries and interprets policy provisions to determine the most effective responses.• Processed 100+ CCN, PC3 (1500 & UB92) claims each day using Facets and mailed documentation to clients.• Communicated effectively with staff , including members of operations finance and clinical departments

Hyattsville, Maryland, United States

• Working knowledge of the NFIP services application, FEMA/NFIP website, Microsoft Outlook, and Microsoft Office applications.• Adhere to Covansys'/LHC policies and procedures.• Resolved customer complaints while prioritizing customer satisfaction and loyalty.• Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.• Reviewed and adjusted customer coverage levels to address, identify and resolve customer conflicts.• Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions.• Position required government security clearance/background check and Personal Identify Verification (PIV) card was issued.

Silver Spring

Washington, District Of Columbia, United States

• Analyzing inquiries that include enrollment, billing, claim adjustments and modifications, interpretation of ICD9/CPT codes, benefits and contracts.• Assisting providers on proper billing practices when submitting claims via UB92 forms, HCFA 1500 forms and electronic billing servers.• Researched and resolved account and service problems with friendly, knowledgeable support.• Led efforts to pursue creative methods to gather and interpret customer perspectives, partnering with senior management in product, strategy and IT initiatives.• Trained new personnel regarding company operations, policies and services.

Washington, District Of Columbia, United States

• Analyzed inquiries including enrollment, billing, claim adjustments and modifications, interpretation of ICD9/CPT codes, benefits and contracts.• Carried out administrative tasks such as handling policy renewals, maintaining records and collecting insurance payments.• Provided quotes and promoted products for various insurance products, including building, contents and vehicle insurance.• Evaluated business and individual customer needs and financial situations to propose individualized policy recommendations.• Analyzed retention, loss ratio trends and sales volume to identify areas for improvement.