1. Lesley B. Caudill
160 4th Street c)859-492-6111
Pikeville, KY 41501 lesleyc3@gmail.com
Claims Correspondence Advocate
ClaimsCorrespondence Processorwithexperienceprocessingpayment/denialofphysician,hospital,and specialty
claims.Thefollowingarerecognizedstrengths:
Work independentlywitha high degreeof accuracy Researchorrequestinginformation needed
Strong abilityto analyze, and problem solve Goodcommunicationskills;verbalandwritten
QuickResponse Time/Resolution Strong abilityto followingpolicyguidelines
I have experiencewiththefollowingprograms/systems: HSS, HOD-CAS, CAS, MTV,DocumentDirect,Macess,
MacessEXP, ContractInformationSystem, Communicator,IDCardManagementSystem, ClaimsXTen,Clinical
GuidanceExchange,CustomerCarePortal2,IPAR TrackingTool,HumanaLegacyHSS, and BCOP.
CAREER HISTORY
ClaimsProcessing SpecialistII,2011-2015 Humana/BluegrassFamilyHealth,KY
A Claims Processing Specialist II is responsible for processing and input of all necessary data for claims into the system and
approval of payment. The Claims Processing Specialist II is responsible for research or requesting information regarding
payment of claims, following policy guidelines for processing claims, and review of all system edits.
CustomerAccessAssociateSenior,2010-2011 UniversityofKentucky
The primary responsibilities of the Customer Access Senior, for the UK HealthCare Patient Access Call Center include:
resolution of escalated Patient Access problems; hire, train, coach and supervise Customer Access Associates; monitor work
groups performance, as well as volumes, productivity, audits and accuracy reports; commitment to excellent customer service;
process standardization activities of workflow and efficiency improvements; ensure compliance with University, federal, state,
and local regulations.
SRS/ SIT Analyst/CustomerServiceRepresentative,2005-2010 Humana/BluegrassFamilyHealth,KY
Provide helpful, friendly customer service for members under the Commonwealth of Kentucky state insurance plan. Extensive
experience with the State of Kentucky self-funded insurance plan including benefit information, pre-certification of medical
procedures, enrollment, claims processing, Coordination of Benefits (COB), and provider contracts. Duties include routine
contact with the Kentucky Retirement System, Kentucky Teachers Retirement System, and the Department of Employee
Insurance to update/verify enrollment information.
As a SRS, one works to achieve a better understanding of the first call resolution, reviews the member complaint, listens to and
collects data related to the complaint, works within the organization/management to resolve the member’s complaint by problem
solving, and makes contact with the member to establish a line of communication and resolution.
A Service Improvement Team (SIT) Analyst collects the data provided through the ECHO program for the propose of noting
trends and providing useful data to better educate Customer Service Representatives (CSRs) to improve their customer service
rankings.

2. AccountsReceivableSpecialist,2004-2005 KentuckyHand and Physical Therapy
Manage commercial insurance accounts, worker’s compensation, post therapists’ daily charges, sorting and distribution of daily
mail, daily deposits, and posting of patient payments. Manage patient accounts by generating monthly statements, monitoring
patient payment plan accounts, generating past due letters, and communicating final collection accounts to an outside collection
agency.
BillingCoordinator,2003-2004 DiagnosticRadiologySystems(DRS)
Entering patient demographics and insurance information, sorting and distribution of daily mail, daily deposits, posting of
insurance and patient payments, verify coding for procedure, update and maintain commercial insurance contracts, posting of
daily charges, and electronic claims filing. Maintain monthly data for monthly for month end, report financials to accounting.
Financial Counselor,2003 UniversityofKentucky
Duties include patient registration and scheduling, checking patients out, helping patients with questions, answering phones, and
filing.
AccountsReceivableSpecialist,2003 MRI Associates
Manage patient accounts, process patient accounts to be forwarded to an outside collection agency. Manage medical records for
worker compensation as well as attorney request. Process secondary insurance claims filing and follow up.
OfficeCoordinator,2002 North ParkEye Center
Provided administrative support for satellite office, prepare and maintain satellite office information, physician contracts and
reports. Managed and ran daily operations. Scheduled and maintain calendar of appointments and meeting for physician and
staff, payment posting and collection of patient fees, data entry and insurance filing.
SurgeryScheduler,1999-2002 Omni EyeServices
Schedule and coordination of all surgical procedures, requires pre-certification from the insurances company, assuring that any
special supplies and equipment are available and ready for surgery. Maintain surgery schedule and schedule post-op visits.
Provide office support through credentialing, and marketing of physicians.
PatientAccountRepresentative,1997-1999 ChattanoogaHeartInstitute
Manage patient accounts by generating monthly statements, monitoring patient payment plan accounts, generating past due
letters, and communicating final collection accounts to an outside collection agency.
EDUCATION
Red Bank High School, Chattanooga TN
Chattanooga State Community College, Chattanooga TN -20 hours