Customer Service Medical

Sandra Stafford

**** *. **** ****** ************, PA 19131 **************@*****.*** Phone: 267-***-****

EDUCATION

Pennsylvania Institute of Technology Philadelphia, PA Associate in Science of Allied Health Graduated 08/2013

Medical Billing/Coder Diploma 10/2011

SUMMARY OF SKILLS

Insurance Billing Bookkeeping Data Entry Medical Terminology Record Keeping

MicrosoftOffice Suite Customer Service Communication Typing Filing Organizing Telephone Etiquette

EMPLOYMENT

AmeriHealth Caritas Philadelphia, PA Claims Examiner 05/2015 –Present Responsible for reviewing and adjudicating medical claims based on the provider and health plan contractual agreements and claims processing guidelines. Follows all internal processes and procedures to ensure activities are handled in accordance with the departmental and company policies and procedures. Medicare specialist.

University of Pennsylvania Hospital Philadelphia, PA Radiology Hospital Aide (temporary) 07/2013 –09/2013 Assist technologist in providing appropriate, timely, and quality service. Sanitize and prep area for radiology procedures. Maintain and gather instruments and medical supplies. Transport specimen to pathology department. Answer phones. Reply to inquiries. Provide updates.

Home Helpers Montgomery, PA Home Support Aide 12/2004 –03/2011 Participate in developing, implementing, and administering care to clients in accordance with established care plans. Write daily updates of clients inside the Home Helpers Care Plan book. Observe and record unusual changes, symptoms, or reactions from clients. Report concerns to the client care coordinator in a timely manner. Provide emotional support to clients and their family members. Spend on-on-one time in communication with clients to keep them abreast of current events and personal activities. Transport clients to doctor appointments, shopping, therapy sessions,and other general errands.

AETNA/U.S. Healthcare Blue Bell, PA Senior Claims Examiner 09/1995 - 2002 Analyze and approve routine claims that could not be automatically adjudicated for homecare. Coordinate responses for routine phone inquiries. Apply medical necessity guidelines; determine coverage; and complete eligibility verification. Identify discrepancies and apply all cost containment measures to assist in the claim adjudication process. Proofread claims or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, diagnosis, and pre-coding requirements. Utilize knowledge of ICD-9 & CPTcodes.

Contact this candidate