Marlena Plummer Email & Phone Number

Islandia, New York, United States

• Responsible for design and development of analysis and reporting of claim, providers, authorization, members, financials, and clinical data using SQL server tools, statistics, and analytical techniques to fully.
• Prepare monthly status reports, aid in corporate projects that deal with health care, compare medical budgeting to their prior analysis, and assist in customer service issues
• Carefully reviewing report requests to get clear understanding of what is requested, gathering additional information as needed
• Analyzing query results and clearly present findings both qualitatively and quantitatively to the requestor, strategically providing additional information that the end-user may need
• Utilizing a robust QA process to present client with a finished product

Islandia, New York, United States

• Tested the validity, accuracy, and consistency of new and existing intelligence data.
• Reviewed complex and unusual claims to determine coverage restrictions.
• Investigated concerns such as billing and claims questions on behalf of providers.
• Checked claims coding for accuracy with ICD-10 standards.
• Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
• Applied HIPAA Privacy and Security Regulations while handling patient information.

Islandia, New York, United States

• Informed customers about billing procedures, processed payments, and provided payment option setup assistance.
• Trained 5 new employees each quarter in procedures and policies to maximize team performance.
• Documented conversations with customers to track requests, problems, and solutions.
• Stayed current on HIPAA regulations, benefits claim processing, medical terminology, and other procedures.
• Based the payment or denials of medical claims upon well-established criteria for claims processing.
• Answered up to 70 calls per day in a fast-paced environment, transferring callers to appropriate personnel.

Bachelor Of Applied Science - Basc, Health/Health Care Administration/Management

Certification, Medical Billing & Coding

Associate Of Arts And Sciences - Aas, Early Childhood Education And Teaching