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Medical Microsoft Office

Location:
Avondale, Arizona, 85392, United States
Posted:
November 16, 2018

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Resume:

Kim M. LaPlante

***** **** ******** ******, ********, Arizona 85392

623-***-**** ac7pvp@r.postjobfree.com

PROFESSIONAL PROFILE

Proactive, detail-oriented, and customer-service driven healthcare professional with over 13 years of progressive medical claims experience. Seeks to contribute to the overall success of an open, all-inclusive, forward-thinking organization by utilizing key relationship building skills and extensive healthcare industry knowledge. SUMMARY OF QUALIFICATIONS

Effective at culling research and evaluating abstract data

Exceptional written and verbal interpersonal communication skills

Superior work ethic combines professionalism, honesty, and ambition

Strong project management skills with the ability to meet deadlines

Knows how to leverage technology to improve overall team performance

Resourceful, estimates and manages time accurately, and has a strong analytical nature

Proficient with specialized billing and coding software, Microsoft Office Suite, and standard office equipment WORK EXPERIENCE

MEDICAL CLAIMS REVIEWER TriWest Healthcare Alliance Phoenix, Arizona 12/2014 - 6/2018

Reviewed, evaluated, authorized, and monitored services provided and received through the Veteran’s Choice Program

Assumed responsibility for maintaining HIPAA compliance with regards to billing and coding practices

Examined all complaints and grievances received from veterans to determine course of action to resolve their issues

Assisted with special projects working with providers on their accounts payable and accounts receivable processing and procedures

MEDICAL CLAIMS ANALYST II Care1st Health Plan of Arizona Phoenix, Arizona 1/2014 - 9/2014

Maintained, completed, and updated key resource materials necessary to effectively process claims

Settled claims in accordance with health plan guidelines, company standards, and processing procedures

Implemented and applied medical cost containment procedures and guidelines to providers of medical care and utilization practices

MEDICAL SENOIR CLAIMS BENEFITS SPECIALIST Aetna Health Care of Arizona Phoenix, Arizona 12/2006 - 11/2013

Reviewed and adjudicated specialized claims for new line of business

Performed the role of subject matter expert by providing training for colleagues

Assisted with the backlog in other areas of the company, such as refunds and encounters TECHNICAL SKILLS

Refunds/Encounters Medicare/Medicaid Billing Process HIPAA Compliance Facets Healthcare Software Q Max and Q Nex Systems Software Medical Terminology Billing/Coding Federal/State Regulations Private Pay/Insurance DRG Procedures EOB Interpretation Claim Review/Analysis



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