Marie Barbee
Meritain/CVS Health
Newark,DE
1
Certification
19
years of professional experience
Experienced with processing and evaluating complex claims. Utilizes analytical skills and attention to detail to ensure accurate benefit determinations. Knowledge of regulatory requirements and effective communication for efficient claim resolutions.
Work History
SR. Claim Benefit Specialist
1 Year 1 Month- Review, research, and adjudicate complex, sensitive and specialized medical claims.
- Make claim adjustments and rework calculations for overpayments. Underpayments and other claim discrepancies.
- Handle claim reconsiderations, appeals, and preauthorization related inquiries.
- Ensure compliance with company policies, client plan provisions, and applicable regulations.
- Process provider refunds and returned check.
- Serve as a subject matter expert by mentoring other claim specialists and assisting with escalated or technically challenged claims.
- Resolved complex claim issues and responded to member or provider inquiries to enhance customer service.
- Act as the designated plan/group owner, ensuring accurate administration of client specific plan provisions, benefits, and processing.
- Partner with internal departments to address escalated claim inquiries and implement resolution strategies.
- Maintain ownership of assigned client groups, ensuring claim accuracy, quality standards, and timely issue resolution.
Pediatric Intensive Care Nursing Assistant
5 Years 9 Months- Maintained adequate stock of all necessary equipment and supplies in designated areas to ensure readiness for patient care.
- - Demonstrates proficiency in the care of patients of all ages: neonates, infants, toddlers, school aged, adolescents and adults
- Provided direct patient care, supporting daily activities such as bathing, feeding, and play.
- Uses Hospital Information Systems as required for patient care, (e.g. documenting vital signs and patient care activities.)
- Accurately relays information from physicians, nurses, laboratory personnel and others.
- Used Hospital Information Systems for patient care, documenting vital signs and care activities.
- Contacts pharmacy, dietary, and other departments as designated by the Registered Nurse.
- Transported patients and delivered reports and supplies to other patient units or Institute locations.
- Covered the patient care unit front desk, answering telephones, greeting patients, and processing mail.
- Participated in departmental and hospital programs for quality assessment and improvement, identifying opportunities to enhance services and making recommendations.
- - Engaged in educational programs for unit, department, and hospital to enhance skills.
- - Engaged in consistent meetings with unit and departmental teams to collaborate on objectives.
- - Attends unit/departmental meetings regularly.
Encounters Correction Analyst/ SR. Claim Benefit Specialist
2 Years 5 Months- Analyzed and resolved encounter rejections, ensuring compliance with state regulations and facilitating timely submissions.
- Provided training and guidance to staff as subject matter expert, enhancing team knowledge and performance.
- Collaborated across departments to ensure audit readiness and uphold regulatory adherence.
Lead Patient Service Representative II
3 Years 6 Months- Managed patient registration, insurance verification, appointment scheduling, and provider support.
- Ensured clinic organization by communicating delays or issues to patients and staff.
- Kept the outpatient clinic organized and tidy. Communicated with patients regarding any delays in the clinic's schedule.
Patient Financial Billing Representative
3 Years 4 Months- Resolved claim issues and discrepancies, ensuring accurate billing through Epremis and internal systems.
- Verified provider NPI and corrected insurance payment errors to maintain compliance and accuracy.
- Prepared and distributed paper claims, facilitating timely processing and reimbursement.
Senior Claim Benefit Specialist
5 Years 5 Months- Reviewed high-dollar complex claims, ensuring compliance with policy guidelines.
- Trained and coached staff, enhancing resolution of escalated issues.
- Acted as liaison between internal departments and stakeholders.
Education
High School Diploma
Skills
Verbal and written communication
Encounter Correction (3+ years)
Teamwork
HealthTech software
Claims management
Customer support
Customer service
Excellent Communication Skills
Strong Collaboration Skills
Strong Technical Skills
Proficient in Microsoft Office
Excellent Organizational Skills
Client Relationship Management
Results-Driven
Encounter resolution
EDI submissions
Highly motivated
Certification
BLS (Basic Life Support)
Timeline
SR. Claim Benefit Specialist
Meritain/CVS Health
07.2025 - CurrentRead More
Encounters Correction Analyst/ SR. Claim Benefit Specialist
Aetna/CVS Health
11.2022 - 04.2025Read More
Pediatric Intensive Care Nursing Assistant
Nemours Children's Hospital
03.2020 - 12.2025Read More
Lead Patient Service Representative II
Nemours Children's Hospital
09.2016 - 03.2020Read More
Patient Financial Billing Representative
Christiana Care Health System
04.2013 - 08.2016Read More
Senior Claim Benefit Specialist
Coventry Health Care
11.2007 - 04.2013Read More
Christiana High School
High School Diploma
Read More