Jessie Moment

Baltimore, MD ***** ac4jll@r.postjobfree.com 443-***-****

Data Entry Specialist/ Claim's Examiner

SKILLS

Data Entry

Medical Claim Processor

Copier

System Tool's

Payroll

Lockbox

Payment processor

Charge Entry

Credentialing

Proficient in Microsoft Office Suites; i.e. Word, Excel, and Outlook

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Claims Processor III

Clerical Administrative

WORK EXPERIENCE

Grievance and Appeals Coordinator

Healthcare Scouts Inc. - Baltimore, MD 10/2017-12/2017

Worked in Grievance's and Appeals department doing approval or denials on Emergency Room bill's based on Sudden or Serious criteria for client MD Physicians Care for Centene. Also copy and pasted on letter's provider address’s send approval or denial through manual fax or Fax-Com systems.

Given another role of appeal status sent by customer service the status of appeal by member's #, DOS, etc. Would send either information to the provider or customer service rep or contact them by phone. Systems used AWD, Tru-Care.

Claims Adjuster/Claims Examiner

Cognizant formerly Trizetto - Linthicum, MD 02/2016-10/2017

Kept the department's claim inventory current and clear edited queues by process claims according to verification of eligibility, interpretation of program benefits, and provider contracts to include manual pricing

Conforming to established standards of performance for quality and timeliness

Correctly match authorizations to claims

Coordinated benefits/other health coverage

Maintain current desk procedures and reference materials

Identify and report billing errors, collaborate to improve processes

Excel spreadsheet Projects in which Adjusting claim to deny or pay

Medical Claims Processor III

Korak Healthcare Staffing - Baltimore, MD 08/2015-12/2015

Processed Commercial Medical Claims Processor in order to we use Wiz Tool in order to follow procedures on how to work Warning message on claim's and route claim's to dedicated examiner's if necessary.

Work Electronic and Paper submitted claims.

Used knowledge of claims processing to examine all types of claims and identify key elements and processed based on diagnosis, provider, pay-key, medical policy, contracts, and policies. Researched and processed highly

Complexed and non-standard claims adjusted, may involved various products such as Indemnity, PPO, HMO, POS, etc.

Accomplishments

Learning of Facets and other systems and ICD 10 Tools Inquiry, Price Calculations, etc. Production with quality weather its Monetary or Procedural. My Quality and Production is noted.

Charge Entry Specialist

Aerotek - Hunt Valley, MD 04/2015-07/2015

Enter charges for Next-Gen Healthcare, for various provider like Medicare, BCBS etc. For their client's North Illinois and Centenga on EHR website.

Print and mail claims for client.

Identified bills by patients account number and the encounter Date of Service to bill CPT and diagnosis codes.

Worked with excel spreadsheets.

Accomplishments

My skills as Data Entry Specialist with clerical and high production with excellent accuracy.

And used my Medical billing /coding to process the information.

Clerical Administrator

Aerotek - Baltimore, MD 10/2014-02/2015

Prepping and pulling of custom paper for vessels for Military vehicles for import back to US service members.

Also research for service member’s information if not provided, using system like ABI and Ial Trax logistics system.

Input custom information to ABI system for service member documents to go custom division to get stamped paperwork for pick up at ports of delivery of automobile.

Scanned documents, printed Bill of Landing, made copies, file, etc.

Accomplishments

Learning about custom documents, different systems like ABI and Trax systems.

Senior Claims Adjudicator

Novitas Solutions/Venturi Staffing 04/2008-10/2013

Process and adjust or cancel Medicare Part A Claims for denial / payment. Have locations to work on daily basis.

As head of Credit Balance inputted provider number for zero balance and positive credit balance to be work in Credit Balance systems.

Production Base with high volume's.

Trained other co-workers in Credit Balance

System knowledge of Oracle, Excel, Word, etc.

Data Entry Operator I/ Exceptional Processing

Bank of America - 09/2006-03/2008

Worked in Payment Services Department entered Customer Payments to BancTec system to Credit Card Accounts.

Mainly Numeric Inputting. Keystrokes required for this job is 12,500, I key approximately 12,500 - 13,300 per hour. Also some Alpha-Numeric.

With average accuracy. In Exceptional Processed looked up customer account number in Image view, Rumba, Fast Data Web,

Customer Relationship Management systems.

EDUCATION

State of Maryland General Studies/Diploma

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