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Medical Billing Training

Location:
Wilmington, Delaware, United States
Posted:
September 22, 2018

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Resume:

Selina Woodard

*** * **** ******, **********, DE 19802

917-***-****

ac644l@r.postjobfree.com

Work Experience

Healthfirst 07/2012-06/2018

Senior Claims Examiner

Responsible for the accurate investigation, examination and resolution of claims

Verify claim charges; investigate eligibility, review benefits, document findings

Process claims for both Medicare and Medicaid

Provides Training and or cross-training to staff

Performs other related duties and projects as assigned

Health Care Partners 11/2009-06/2012

Senior Claims Adjudicator

Adjudicates or processes health and/or dental benefit claims for payment.: In a senior capacity, reviews and adjudicates complex or specialty claims and provides training to lower level Claims Adjudicators.

Determines whether to return, suspend, deny or pay claims within established policies and procedures.

Analyzes and answers inquiries regarding claim adjudication, including method of payment, co-pay or deductible amounts, and or reason for denial.

Adjusts claims that have been denied, overpaid or underpaid. Routes claims requiring additional information or high-level decision-making.

Researches claims and appeals as needed.

Requests information from internal or outside sources to ascertain completeness and validity of claim including coordination of benefits information.

Analyzes claims to determine extent of liability and settles claims with claimants in accordance with policy provisions.

Acts as Team Leader, as needed.

Keystone Mercy Health Plan 12/2006-11/2009

Claims Analyst

Responsible for the accurate investigation, examination and resolution of claims

Verify claim charges; investigate eligibility, review benefits, document findings

Provides training and or cross-training to staff

Supports telephone lines as necessary

Assist team leader with pre and post daily reports

Performs other related duties and projects as assigned

Cigna Health Care 3/1994-8/2006

Medical Claims Processor II

Responsible for the accurate investigation, examination and resolution of claims

Verify claim charges; investigate eligibility, review benefits, document findings

Assist team leader with pre and post daily reports

Education

Dawn Training Institute

Medical Billing Certification Diploma



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