Customer Service Medical

Phyllis Brown

**** *. ******* ***** **, #***

Carrollton, TX 75006 **************@*****.***

Phone: 214-***-****

SUMMARY OF QUALIFICATIONS:

Extensive background in Medical,Disability and Dental claims

processing. Knowledge of medical terminology,CPT HCPC ADA

codes Adjudication of complex and sensitive claim

situations. Extensive travel as a consultant for clients

with huge backlogs systems RIMS,DIAMONDS NASCO and other

home grown claims systems Auditing,Plan Building Customer

Service Provider Relations ICD-9 and Coding

EXPERIENCE:

March 2010

to

Present

April 2008

to

March 2010

March 1997

to

September 2007

January 1994

to

December 2006

EDUCATION:

HealthSmart Benefit Solutions Irving, TX

Auditor

Auditing of medical clams from examiners in the claims department Assuring

that the claims have been processed correctly according to the plan

documentation from the vies

groups. that deductibles have been applied and out of pocket benefits have

been processed and that coordination of benefits are correct claims are

processed according to R&C to charge errors as a learnig tool for the

examiners as well as the Auditor

UT Southwestern Medical Center Dallas, TX

Medical Claims Analyst

Investigation of complex Medical claims for collections for the Hospitals

Verifying that claims have been posed correctly to the patients accounts.

For claim denials gathering of

documentation and information for appeals to the various Insurance

companies in a timely manner, Recommendation of claim write offs or self

pays once the insurance companies

have meet their obligations. Adhere to production,quality and departmental

guidelines.

The Jacobson Group Chicago, IL

Claims Examiner/Customer Service

Extensive travel to various cities for claims processing of Medical

claims,Disability Claims answering of incoming calls from clients and

providers. due to claims backlog volume Approval or Denial of claims

according to plan contracts Performance within the departmental guidelines

according o the clients demands and expectations

Insurance Overload Dallas, TX

Claims Examiner

Adjudication of claims Approval and Denials of claims production and

quality within client guidelines. Answering of incoming calls from clients

and providers with claims issues about the status of claims in a timely

manner.

KEYWORD SUMMARY:

Seeking a challenging position To best utilize my experience

and skill sets being given the opportunity a be a team asset

in and for the department. A opportunity for advancement in

this ever changing profession

Contact this candidate