Close Close Preview

Your amazing online presence is right this way.

Create your profile
Capture who you are, what you do, and where you're going. All in one place.

Delores Howard- Holmes

Delores Howard- Holmes

CEO of Birdsparadise Travel

Birdsparadise Travel

Attended University of Phoenix

Message
MENU ☰

Birdsparadise Travel

CEO of Birdsparadise Travel

I take pride in introducing people to an incredible opportunity that offers the potential to change their lives in tremendous ways. I represent a travel company that has already sold 7 trillion dollars in travel and e-commerce and is continually growing.

Career medium 01
Career
Career medium 05

Dr. Dave Webster Family Medicine

Dr. Dave Webster

Extensive training in Windows based Advanced MD electronic filing system; proficient in verification of patient eligibility and benefits; editing and adjusting of patient daily charge slips to ensure appropriate coding via ICD9CM, CPT, and HCPCS protocol; balancing and logging of daily receipts, insurance checks, and patient payments; adjudicated explanation of benefits (EOB) for denials and third party liability.

Career

Scott & White Health Plan & Insurance Company

Manpower-Membership Specialist/Call Center Specialist

Processed enrollment applications for lines of business to include Health Plus, Young Texan, Senior Care, and Texas Rx; processed APS bank information for requested automatic bank drafts; processed changes to coverage and termination of coverage requests. Answered 30+ telephone inquiries in reference to Medicare Part D in an effort to provide information to our valued clients to assist them in making informed decisions regarding their prescription drug coverage. Utilized Microsoft Access database to schedule clients for information seminars to allow clients an interaction with various company personnel to include pharmacy and finance to explain the health plan formularys and coverage; performed as lobby receptionist for member requests for assistance from various department representatives to include marketing, finance, and claims; accepted member premium payments and issued receipts.

Career medium 06
Career
Career medium 01

Omnicare TPA Inc. of Detroit (formerly U.A.H.C)

Claims Quality Control Coordinator

Monitored claims inventory to evaluate total number of claims received for each claim type both professional and facility; analyzed claims process flows to identify problems initiated during claim scanning, eligibility checks, or Julian date order which impacted production or processing time; pursued and recommended alternatives and resolutions for outstanding payment issues regarding determination of other carrier liability and possibility of provider incorrect billing practices; conducted quality assurance audits on Lead Analysts, Claims analysts, Provider Inquiry Specialists and Coordination of Benefits Specialists; ensured that errors found were addressed and corrected within company guidelines with documented verbal warnings as required; maintained daily administrative reports to reflect total number of claims processed per analyst, number or errors and processing time per hour for all analysts; ensured staff training on various companies individual contract updates related to benefit eliminations or additions, contract stipulations, and new company's contracts.

Career

United American Health Care (U.A.H.C)

Claims Inquiry/Provider Inquiry Supervisor-C.O.B Specialist-Lead Analyst

Supervised 13 Claims Inquiry/Provider Service Inquiry Representatives by monitoring telephone inquiries to ensure adequacy and proficiency of relayed information; trained Lead Analysts, Claims Analysts, Claims Inquiry Representatives, Provider Service Inquiry Representatives and Coordination of Benefits Specialists; Implementation Team Leader for upcoming MC400 automated adjudication system to entail development of configuration logic, benefit categories, fee schedules and adjudication rules. C.O.B Specialist-researched and determined carrier liability through possibility of coordinated benefits using the longevity law, birthday law, or the gender rule; retrieved any payments made prior to knowledge of other carrier by processing information letters of credit retrievals or reimbursement requests; structured subrogation cases with attorney's office for workmen's compensation or lawsuit compensation; resolved correspondence requests for denied claims. Lead Analyst-processed inpatient admissions, outpatient procedures, office visits, home health, physical therapy, vision, radiology and laboratory claims; responded to payments other than anticipated (P.O.T.A) requests; resolved and reprocessed denied/rejected claims.

Career medium 05
Career
Career medium 04

Alsan Medical Clinic

Medical Biller

Verified patient eligibility and benefits; expedited medical coding via the HCFA 1500 claim form to various insurance carriers; collected applicable outstanding balances, co-pays, and coinsurance payments; scheduled patients for inpatient hospital admissions, outpatient clinical procedures and follow-up appointments.

Career

Blue Cross Blue Shield of Michigan

Correspondence Expeditor-Claims Adjudicator

Confirmed benefit eligibility referencing the company's summary of contracted services and issued applicable payment; analyzed provider and subscriber correspondence regarding denied services and/or benefit clarification. Claims Adjudicator-examined and processed inpatient facility claims, outpatient ambulatory services and office visit claims; processed denied claims reports.

Career medium 01
Career

University of Phoenix

Bachelor of Science, Health/Health Care Administration/Management