Claims Specialist with years of experience

*******@*******.*** 651-***-****

Lisa Schmeltzer

Accomplishments

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

Professional Experience

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.

Software Skills

• Microsoft Office, Visio, Adobe Photoshop and Illustrator,

Education

Business Communication – University of St. Thomas, St. Paul, MN 2008 -

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