Medical Billing Training
Resume:
Selina Woodard
*** * **** ******, **********, DE 19802
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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