Resume

Sign in

Customer Service Medical

Location:
Hampton, Georgia, United States
Posted:
August 25, 2018

Contact this candidate

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

ac6s8q@r.postjobfree.com

206-***-****

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



Contact this candidate