Customer Service Medical
Resume:
SKILLS
Every company can expect a very thorough and meticulous claims examiner and processor, I can easily how to process and correct any outstanding errors on claims. I will help take production through the roof with my amazing work ethic and energy. Also audited claims
EXPERIENCE
EMPLOYMENT HISTORY:
Dell (Claims Adjustor)
August 2017- March 2018
Adjudicate claims from Powerstepp work queue
Resolve all quality issues in the AWD QA environment as required
Attend all web based training on new processes as needed
Compliant with all in house training per the client requirements
Work on special projects as required
Maintain daily production goals
Resolve all pended claims within client guidelines
Community First Health plan (CSHP) Grievances and Appeals
May 2016 – June 2017
Responsible for accurately adjusting and adjudicating medical claims as assigned, manage and respond to all provider inquiries regarding their appeal status. Reviewing and researching requests regarding adjustments and appeals in a timely manner on Amisys 6.6.
Group Health. (Claims Auditor)
November 2015-March 2016
For Group Health I helped reduce operational losses that are commonly found in instances such as policyholder fraud and deceit. I would review reimbursement request to be sure that the requests had validity.
Senior Claims Adjustor- Blue Cross Blue Shield Of Louisiana
Employed March 2014 -- February 2015
Analyzed and adjusted both Medicare & Medicaid claims to pay the correct amounts to the provider, i also made sure there were no overpayments and if there were potential overpayments to a provider i would set up a refund task to take money back. Providers would also send in 11 status claims or a (Corrected Bill) so that we could make corrections on the 02 or (original claim) that was sent in. Proficient Medicare Knowledge, Understand COB 100%
Claims Adjuster - Dell Services – Seattle, WA (Remote)
Employed October 2012 – December 2013
Processed medical claims from assigned work queue
Manage and resolve any errors as needed
Ensure procedure pricing accuracy is obtained
Attend scheduled online trainings and meetings as required
Claims Processor- Blue Cross – Lynnwood, WA
Employed January 2010 – Aug 2012
Processed Medicare and Medicaid claims for payment
Met the quantity and quality requirement goals daily as expected
Interpreted provider contracts and discounts as applicable
Audited claims for accuracy
EDUCATION
Mount Tahoma High School
Tacoma, WA
Kennesaw State University
Computer Science Major
(2016-2018)
Expected Graduation 2021
*************@*****.***
LinkedIn URL
Twitter handle
Link to other online properties: Portfolio/Website/Blog
SKILLS
Contracts Specialist, Facets Expert, CPT Coding, Proficient COB knowledge, Internet Literate MS Office Suite, MS Outlook, Windows 8, Pricing, Great Quality and Accuracy, Power MHS, Amisys
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