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Customer Service Medical

Location:
Philadelphia, Pennsylvania, United States
Posted:
February 28, 2019

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Resume:

HAROLD SCRUGGS

*** ****** ******, ************ ** 19111 · Home: 215-***-**** – Cell: 215-***-****

ac8m1t@r.postjobfree.com

Driven Medical Claims Examiner trained in all aspects of insurance claims and collections. Employs high-level negotiation skills in resolving claims to the satisfaction of all involved parties. Analytical thinker and innovative problem

solver.

EXPERIENCE

OCTOBER 2016 – PRESENT

CLAIMS EXAMINER – LONG TERM CARE, capgemini

Responsible for Accurate and Timely Daily Review of Long Term Care Claims

Process Payment or Issue Denial of Claims

Responsible for The Identification, Analysis, and Application of Long Term Care Claim Products, Including Waiver of Premium, Assignment of Benefits, and Credits

Meet and Exceed Production and Quality Targets Established by Management

Operate Within Company Guidelines Regarding HIPPA, Fraud Confidentiality and Private Health Information

NOVEMBER 2015 – OCTOBER 2016

BILLING ANALYST, medrisk

Research and Resolve Problems Concerning Complex Billing, Claim Processing, Case Set Up and Reimbursement Issues

Respond Within Established Time Parameters To Client and Provider Inquiries on Claim Status and Billing Issues Received

Identify and Collect Outstanding Open Accounts Receivable Funds

Effectively Document Actions and Results While Providing Clear and Concise Notes

Communicate Known Issues With All Internal Revenue Operations, Finance, Account Management, Provider Relations and Customer Service Departments

AUGUST 2001 – JANUARY 2015

CLAIMS EXAMINER – MEDICAL, healthnow adinistartive services

Process Medical, Dental, and Flexible Spending Account (FSA) Claims

Process Adjustments of Claims

Manages Correspondence

Maintains Production and Quality Standards By Ensuring All Claims, Correspondence and Adjustments Are Processed In Accordance With Company Guidelines

Respond To Routine Request From Providers, Claimants, Brokers, And All Interested Parties In Writing or Orally

Able To Verify Coverage In Accordance With Company Guidelines and All State and Federal Laws

Verify and Request Medical Information From The Insured, Claimants and Medical Providers

EDUCATION

AUGUST 1990 - MAY 1995

SOCIOLOGY, Bloomsburg university

Completed 72 credit hours

JUNE 1990

HIGH SCHOOL DIPLOMA, mastbaum voc-tech high school

National Honor Society

Football, Basketball, and Volleyball Teams

MILITARY EXPERIENCE

DECEMBER 1991 – DECEMBER 1995

INVENTORY MANAGEMENT/OPERATIONS SPECIALIST, U.S. Air force

Earned Numerous Awards, Medals, and Commendations Including Good Conduct Medal

Trained Personnel In Standard Base Supply System Computer Operations and The Core Automated Maintenance Systems Operation

Awarded Airman Of The Year, 355th Fighter Squadron, 1992

Awarded Technician Of The Year, 355th Fighter Squadron, 1993



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