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