DAPHNE MEDLOCK

**** ******* ***., ***. ** Long Beach, CA 90804

Tel: 562-***-**** Email: ac8dhp@r.postjobfree.com

CAREER SUMMARY

Over 12 years claims and administrative experience with a proven track record in meeting and exceeding goals while adhering to compliance standards and State regulations. Seeking a position where I can utilize my diverse skills and experience to help promote growth and profitability for the organization.

KEY SKILLS AND ABILITIES

Experience in Medicaid, Medicare, HMP, PPO product lines.

Knowledgeable in processing HCFA 1500, PM 160, CPT, HCPC, ICD-9, ICD-10 codes.

Experience in both inbound/outbound call center. Average inbound 80 calls and 20 outbound calls a day.

Experience with QNXT and EZ-Cap claims paying system.

Great computer skills (Word/Excel), Typing 50wpm, Data Entry and Internet functions.

Remarkable customer service.

Good problem-solving and communication skills, both verbal and written and good at interpreting customer needs.

Strong work ethics; well versed with HIPPA, EOB, Health Care and insurance terms.

Quick learner, adaptable in a fast-paced environment and Ability to sustain work pressure in an efficient way.

PROFESSIONAL EXPERIENCE

Claims Administrative Assistant November 2017 – August 2018

Claims Management Solutions – Los Angeles, CA

Supported the Director and Senior Leadership by providing administrative support for their roles.

This included adeptly handling administrative matters including screening calls, managing calendars and planning meetings, making travel arrangements, composing documents and organizing offices for efficiency.

Interacted professionally with all levels of staff and maintained the highest level of confidentiality; known for tact and diplomacy in handling sensitive issues.

Provide general administrative and clerical support including mailing, scanning, faxing and copying to management.

Maintain electronic and hard copy filing system.

Open, sort and distribute incoming correspondence.

Perform data entry and scan documents.

Manage calendar for Director.

Assist in resolving any administrative problems.

Answer calls from customers regarding their inquiries.

Prepare and modify documents including correspondence, reports, drafts, memos and emails,

Schedule and coordinate meetings, appointments and travel arrangements for Director.

Maintain office supplies for department.

Claims Processor September 2007 – August 2017

Molina Healthcare, Long Beach, CA

Responsibilities include processing incoming claims, keying claims into the Managed Health Care Editor System, verification of member eligibility, attending physicians and billing providers for all States in the Production and Encounter Environments.

Track incoming claims and monitor claims volume to ensure all States are maintaining the processing standards necessary for regulatory compliance.

Review and investigate claims to ensure the accuracy of re-routing to the correct environment.

Maintain claims inventory reports on Excel spreadsheets and ensures accurate and timely delivery of incoming and outgoing communications by processing internal and external mail (standard or electronic) upon receipt and facilitating delivery to the appropriate States.

Researches claims that are returned as undeliverable, and process in accordance with regulatory guidance and internal policy and procedures.

Supports department compliance by maintaining logs for various tasks/responsibilities, running and distributing routine and/or ad-hoc reports, and communicating findings to management.

Make copies, filing, send faxes or other standard/electronic communications; collate materials, and deliver/pick up items, as needed.

Assists in other department processes and functions, as assigned.

Claims Clerk October 2003 – September 2007

Molina Healthcare, Long Beach CA

Review, research and match various claim forms and documented for accuracy for completion or to obtain missing information from providers.

Reviewed claims images and input information and changes in the database.

Entered claims daily into database for assignment of CRN and to maintain accurate daily claims volume.

Responsible for calculating claims amounts and submitting claims to examiners for processing.

Investigated problems and provided information and solutions for resolution.

Worked directly with claims supervisor and provider services reps to resolve complex provider issues of unpaid claims. Researched, processed and submitted for payment.

Handled filing, scanning and preparing claims for monthly storage.

Thoroughly documented all processes, inquiries and results for accurate tracking and analysis.

EDUCATION

George Washington Preparatory High School Graduated: High School Diploma

Los Angeles, CA

SALARY

DOE

REFERENCES

Available as requested

Contact this candidate