Customer Service Medical
Resume:
Kelly Kleber
Valencia, PA, **059
ac1eou@r.postjobfree.com
Objective: To acquire a challenging position in the Pittsburgh area that will allow me to apply and enhance my professional knowledge and experience.
Qualifications:
Extensive experience in a customer service environment
Outstanding interpersonal and communication skills: demonstrated ability to maintain close relationships with clients, catering to their independent needs on a daily basis
Strong analytical and problem solving skills.
Typing-50-60 WPM
Strong desire and ability to learn quickly
Exceptional capacity to multi-task.
Knowledge in Microsoft Word and Excel, as well as Peachtree Accounting System
Employment:
Fideliscare, Buffalo, NY
Claims Review Analyst, Nov 2014 - present
Investigate reported issue; determine the cause of the problem; select and explain the best solution to solve the problem and expedite correction or adjustment; follow up to ensure resolution.
Complete all necessary paperwork and documentation to properly adjudicate claims and to provide information for more effective troubleshooting in the future.
Audit, verify, compile, and analyze provider, member, and contract data to determine any payment discrepancies and substantiate accurate claim payments; prepare formal responses to requests received.
Prepare, process, and reconcile documentation to ensure accurate and timely payment of claims.
Collect, analyze, and summarize data to prepare reports and make recommendations.
Apply service and quality procedures to identify and resolve issues that may hinder the successful completion of the claims project.
Claims Processor, Jan 2013-Nov 2014
Processed medical HCFA and UB92 claims, including medicare
Pricing APC claims and adjudicating
Utilizing knowledge of medical terminology and medical CPT codes
Releasing, denying and routing of hospital and medical claims after reviewing on pended claims report.
Maintaining personal route que. Working knowledge of Facets system.
Lawley Benefits Group, Buffalo, NY
Flex Claims Administrator. 2011-2012
Responsible for maintaining over 20 companies.
Processed employee’s claims, analyzing medical bills and EOB’s from other insurance carriers in order to verify payment amounts.
Entered enrollments, printed flex checks and processed terms.
Gave exceptional customer service to employees and developed close working relationships with their employers
Audited debit card feature in Lighthouse 1 processing system
Veneer Systems Inc., Buffalo, NY
Administrative Assistant. 2008-2011
Answered telephone, taking customer orders
Shipped products through various shipping companies, including, UPS, US Postal, Fed-Ex. Sending and filing invoices, running credit cards, crediting checks and printing checks for vendor payment all in Peachtree Accounting System.
Made bank deposits.
Called customers for past due amounts.
Ordered products for inventory.
Often called upon to run business solo for a week’s time period.
NOVA Healthcare/Independent Health, Grand Island, NY, 1997-2007
Flexible Spending Account Analyst/Dental Claims Examiner/Medical Claims Examiner/Technical Claims Analyst
Flexible Spending Account Analyst
Analyzed and processed employee flex claim reimbursements according to Sec. 125 guidelines.
Answered phones pertaining to questions on cafeteria plan, balances, and trouble shooting any problems with payments or accounts.
Printed and mailed manual checks to employees or employers according to set schedule of distribution.
Dental Claims Examiner
Processed and reviewed dental claims manually, including preparation of pre-treatment estimates.
Medical Claims Examiner/Technical Claims Analyst
Knowledge of medical terminology and medical CPT and ADA codes.
Processed and reviewed medical HCFA and UB92 claims.
Knowledge of HIPAA LAW.
Responsible for learning individual SPD's for my own companies. This also included coordination of benefits with other insurance companies. Answering client relations phone calls pertaining to provider/employee inquiries.
Maintained current position while promotion to Technical Claims Analyst.
Duties included preparing and organizing workload for 8 or more team members.
Distributing and sorting daily correspondence, consisting of pre-existing, accident and HIPAA letters.
Noting ECI claims system. Reviewing and paying current stoploss (high dollar) claims to make sure they got paid according to company's stoploss schedule.
Flexible Spending Account Analyst
Returning to Flex Department, same duties as above, now maintaining MBI credit card system. Adjudicating claims on MBI website. Maintaining close working relationship with clients.
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