patricia ann boyle

Patricia A Boyle


Summary:



  • Sending out corrected medical claims to providers and verifying eligibility for insurance coverage through various means

  • Handling and sorting correspondence by scanning documentation into teams share folders

  • Ensure professional handling of all member appeals and grievances in a timely and efficient manner.

  • Utilized broad understanding of all Tufts Health Plan Public Plan products and benefits as well as an understanding of other internal and external constituents about highly escalated issues.

  • Processed assorted claims for payment or denial. The claim representative must possess broad understanding of all Network Health Public Plan products and benefits as well as an understanding of other internal and external constituents about highly escalated issues.

  • Provide accurate coordination, efficient administration and resolution of member claims submitted by Network Health providers for all products.

  • Handle the coordination of benefits to check on other insurance members may have before processing claims for Network Health.

  • Processed different life insurance changes to policies i.e. changes, beneficiary changes. Life of business changes and cost changes. Administrative assistant duties.

  • Requesting medical records and documentation from facilities


 


Skills:



  • Medical records documentation

  • Corrected medical claims

  • Insurance coverage


 


Education:



  • Graduate, Salter School Health Claims Specialist Program, Cambridge, MA 2007


 


Experience:


Maximus, Boston, MA                                                                                                              Oct 16 - Nov 16


Member Services Representative


Responsibilities:



  • Provide customer service to Mass Health members and or potential members.


 


Plexus Management Group, Westwood, MA                                                                            Jun 16 – Oct 16


Medical Record Clerk


Responsibilities:



  • Requesting medical records and documentation from facilities

  • Sending out corrected medical claims to providers and verifying eligibility for insurance coverage through various means

  • Handling and sorting correspondence by scanning documentation into teams share folders

  • Document all activity in system and update accounts per department guidelines

  • Office support to Managers and staff as needed

  • Verifying anesthesia information for payment from providers

  • Rebilling corrected claims as needed


 


Data Bank, Canton, MA                                                                                                            Apr 16 – Jun 16


File Clerk


Responsibilities:



  • Preparing files for scanning in a timely manner. Temporary position


 


Tufts Health Plan Public Plans, Watertown, MA                                                                      Oct 10 – Mar 16


Appeals and Grievance Specialist


Responsibilities:



  • Ensure professional handling of all member appeals and grievances in a timely and efficient manner.

  • Utilized broad understanding of all Tufts Health Plan Public Plan products and benefits as well as an understanding of other internal and external constituents about highly escalated issues.

  • Provided accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Tufts Health Plan Public Plan members (member appeals and grievances) for all products.


 


Network Health, Medford, MA                                                                                                  Jun 07 – Oct 10


Claims Representative


Responsibilities:



  • Processed assorted claims for payment or denial. The claim representative must possess broad understanding of all Network Health Public Plan products and benefits as well as an understanding of other internal and external constituents about highly escalated issues.

  • Provide accurate coordination, efficient administration and resolution of member claims submitted by Network Health providers for all products.

  • Handle the coordination of benefits to check on other insurance members may have before processing claims for Network Health.


 


John Hancock Financial Services, Boston, MA                                                                       May 76 – Dec 05


Salter School Health Claims Specialist Program


Responsibilities:



  • Respond to various daily requests from distribution channel groups providing service to upscale niche markets including Corporate Owned Life Insurance, Estate Protection, Direct Brokerage Service, and M Group Service.

  • Handle daily output, priority mail and work tracking, prepared single Life in force illustrations using Hansel application.

  • Filed all correspondence for audit trail purposes and handling incoming and outgoing mail in accordance with John Hancock Financial Services compliance policy.

  • Prepared/sent out acceptance letters to carriers to ensure timely processing of 1035 exchanges.

  • Processed different life insurance changes to policies i.e. changes, beneficiary changes. Life of business changes and cost changes. Administrative assistant duties.


 


 


 


 


 

  • ID#: 129331
  • Location: Boston, MA , 02124

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