POWELL, NATASHA

213 Baker Street | Suffolk, VA 23434 | 757-934-2219 | napowell79@gmail.com

OBJECTIVE

Compassionate and motivated individual seeking to use organizational and active

listening skills along with degree in Interdisciplinary Studies in order to assist
individuals seeking assistance from the Department of Social Services
EDUCATION

Bachelor of Science, Interdisciplinary Studies

Norfolk State University, Norfolk VA
Concentrations: Psychology, Sociology, Health Service
Management

Expected May 2017

Associate in Science Degree, Social Sciences

Tidewater Community College, Norfolk VA

Obtained May 2012

SUMMARY OF QUALIFICATIONS

Strong decision making, analytical and problem solving skills

Excellent organizational skills and very detail oriented
Proven ability to handle diverse, fast-paced workplace with multiple levels
of responsibilities
Excellent interpersonal relations, project management, and leadership
skills
Daily monitoring of policy and procedure adherence

EXPERIENCE

Senior Claims Resolution Analyst

Amerigroup Corporation

Research and ensure resolution of claim payment

issues to include incorrectly paid claims and
engaging the appropriate departments for
resolution
Assist in the review of state, executive, and
provider complaints to determine the resolution
of their issue in a timely manner
Interact with network providers and internal
customers ensuring the issues are fully resolved
Perform trend analysis
Perform UAT testing
Recommends new or modified
procedures/processes to solve complex problems
taking into consideration the business
requirements and application capacity and
limitations
Conduct bi-weekly meetings with team mates on
unresolved issues
Facilitate weekly account management meetings
for the state of Texas
Conduct training for new hires and remedial
training for existing team members

CAMP Analyst
Amerigroup Corporation

4/2011 - Present

Acts as a liaison for Health Plan and Operational

Departments
Manages customer expectations and
communicates project risks, opportunities and
changes to client and development teams
Responsible for investigating, creating and
maintaining documentation related to business

4/2009 4/2011

scope and objectives, configuration analysis and

requirements, risk assessment of all options and
translates approved request into proper system
requirement specifications.
Responsible for managing and coordinating all
activities related to project scope and its
interdependencies on other department activities
to complete requested and approved projects,
including requesting, validating, and editing of
reports.
Recommends new or modified
procedures/processes to solve complex problems
taking into consideration the business
requirements and application capacity and
limitations.
Investigates and facilitates the resolution of
claims issues, including incorrectly paid claims,
by working with multiple operational areas and
health plans and analyzing the systems and
processes involved in member enrollment,
provider information management, benefits
configuration and/or claims processing.
Identifies the interdependencies of the resolution
of claims errors on other activities within
operations.
Assists in the reviews of state or federal
complaints related to claims. Coordinates the
efforts of several internal departments to
determine appropriate resolution of issues within
strict timelines.
Interacts with network providers and health plans
regularly to manage customer expectations,
communicate risks and status updates, and
ensure issues are fully resolved.
Performs claims and trend analysis, ensures
supporting documentation is accurate and
obtains necessary approvals to close out claims
issues.

Business Solutions Analyst II

Amerigroup Corporation

Perform requirements gathering, analysis, and

process and data flow for simple processes of low
to moderate complexity
Knowledge of the inter-relationship among
various managed care operational areas
Provides business and data analysis support for
new development projects and market
expansions
Reads and interprets design documents
Basic knowledge of current technology trends
Manage the ACM process for Business
Requirements
Lead requirement gathering session with
business owners and other team members
Develop requirements documentation and obtain
approvals of the requirements from the business
owners and other stakeholders
Document key business decisions and processes,
and validate them with the business owner

Claims Supervisor
Amerigroup Corporation

6/2007 4/2009

The daily supervision of claims staff

Monitoring of all aspects of claims processing,

3/2006 6/2007

productivity, and quality assurance for Behavioral

Health, Long Term Care, Summit Care, and
Special Needs Product
Daily coaching and counseling of associates to
assist with meeting departmental standards for
productivity and quality
Handling Provider settlements for the Specialty
Team
Delegating workflow to the claims team via the
Subject Matter Expert and Claims Research
Specialist to ensure claims inventory is properly
distributed
Participating in senior management and high
level meetings relating to staffing and
departmental policies
Conducting weekly team meetings and training
on new claim policies and procedures
Writing and administering of corrective action
Reporting daily Work In Progress and inventory
metrics to Senior Staff
Complete 90 day and yearly evaluations in a
timely manner
Monitor Macess queues to ensure claims are
processed timely
Oversee time management and attendance of
staff
Deliver individual score card to ensure
productivity and quality metrics are met
Attend the Monthly MOR calls for Behavioral
Health
Monitoring the CSR and ensuring the phone
metrics were met
Handle escalated provider calls
Supervised as many as 20 direct reports

Research Specialist
Amerigroup Corporation

Processed and responded to all Behavioral Health

and Long Term Care Projects from the Health Plan
Process RNFs
Mentor and Train teammates on new claims
policies and procedures
Process CAMP Projects and Settlements
Work Correspondence and Phone Logs
Assisted with the training for the Special Needs
Product
Assisted team with any claims questions

Claims Analyst
Amerigroup Corporation

6/2003 1/2005

Processed medical claims for the Texas market

Processed inpatient claims
Work the anesthesia report
Work overpayment and OHI projects for CCU
Work phone logs and correspondence

Senior Claims Analyst

Vicare

1/2005 3/2006

Monitor claims inventory to ensure clean claims

were processed within 14 days and pended
claims were processed within 30 days
Assisted the Plan with escalated claims issues
Conducted 90 day and yearly evaluations
Performed on the job training
Work closely with the Senior Customer Service

5/2001 5/2003

Representative to handle escalated provider calls

Coached, mentored, and developed staff to
ensure individual productivity metrics were met
Processed medical, dental, vision, and flexible
spending claims
Reviewed and released high dollar claims
Conducted weekly team meetings to ensure lines
of communication were open
Supervised as many as 15 direct reports
Oversee time management and attendance of
staff

Directory Assistance Operator

GC Services

Provide directory assistance for business and

residential listings
Verified addresses

Receptionist/File Clerk
Reliance Staffing

3/2000 8/2000

Filed
Answered telephones

Accounts Payable Clerk

Pioneer Southern

8/2000 12/2000

Answered multi-line telephone

Filing
Creating purchase orders
Entering invoices for payment
Set up customer files

6/1996 6/1998