Experience working with HIPPA and ACA compliance regulations
Experience working with medical and dental providers
Experience working with commercial and private insurance carriers
Developed strong relationships across internal work groups
Claims Adjuster – WILSON McShane, Bloomington, MN January, 2013–December, 2015
Third party administrator for Taft Hartley groups
Handled phone calls from patient, providers and business agents
Processed disability payments according to plan specifications
Worked with fund attorney to facilitate subrogation
Processed third party claims including COB
Network Management – HealthPartners, Bloomington, MN June 2008– October 2013
Supported internal and external customers providing timely and accurate information on network affiliated providers.
Investigated and resolved customer inquiries and concerns in a timely and empathic manner.
Calculated usual, customary and reasonable fees (UCR)
Compiled necessary documents for clinic and provider rate pricing
Claim Examiner–HealthPartners, Bloomington, MN November 1985– June, 2008
Responded to inquiries and answered phone calls from members and providers resolving issues, addressing concerns, and supplying requested information in accordance with company policy and government regulation.
Accurately completed appropriate claims paperwork, documentation, and system entry.
Verified claims status and patient and member eligibility with employer representatives.
Routinely maintained diagnostic and treatment procedure codes used in member and patient claims records.
Researched CPT and ICD9 coding discrepancies for compliance and reimbursement accuracy.
• Microsoft Office, Visio, Adobe Photoshop and Illustrator,
Business Communication – University of St. Thomas, St. Paul, MN 2008 -