Leo Pompeo has 17 years of experience in healthcare insurance and is seeking a new career opportunity. He has a Bachelor's degree in Business Administration and has held leadership roles at UPMC Health Plan coordinating benefits and managing staff. His experience also includes senior coordination specialist roles handling complex issues and coordinating benefits for various insurance plans. He has expertise in Microsoft Office, various claims processing systems, and medical terminology.
2.
March 2005August 2011
● Senior knowledge of medical terminology, procedures, claims adjudication and benefits interpretation to
handle complex issues, while maintaining or exceeding designated quality and production goals.
● Coordinate benefits for all lines of business and all products for UPMC Health Plan.
● Working knowledge of End Stage Renal, COBRA, CHIP, Adult Basic, Medicare and Medicaid.
● Interface with other insurance entities by telephone to obtain information regarding coverage while actively
pursued open phone log inquiries and resolve within the designated time standards.
● Assist group enrollment in updating member’s COB files in MC400 as well as other departments during
periods of backlogs
● Document liability and recovery screens with all pertinent information regarding order of benefit
determination.
● Assisted with inbound Medicare Secondary Payer inquiries.
● Maintain or exceed designated quality and production goals.
● Proactively facilitate the team process to meet or exceed goals while Prepare various management reports as
required
● Interact with other departments to identify overpayments due to coordination of benefits
● Acted as a resource for trainees entering the unit
Member and Provider Service Representative, Highmark Blue Cross Blue Shield
January 1998May 2004
● Audited monthly provider remittance reports to ensure accurate reimbursement and resolved all monetary
discrepancies
● Receive calls and inquiries from the Client's healthcare providers and perform appropriate follow up actions
that include assisting providers with questions regarding payment of claims, member eligibility, claim
denials, resolving billing issues, prior authorizations and referrals using multiple resource directories and a
computerized system for tracking, information gathering and/or troubleshooting
● Completed claim adjustments and successfully entered and built new claims into various processing systems
as needed.
● Provide prompt, accurate and courteous replies to written and telephonic member inquiries
● Serviced all of Highmark's products such as Health Maintenance organization, Indemnity, PointofService ,
Preferred Provider organization, and all Medicare and Senior 65 plans
ACCOMPLISHMENTS
● Enrollment and COB Services Team MVP Award winner, August, 2011
References Upon Request