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Customer Service Medical

Hollywood, Florida, United States
October 17, 2016

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Beverly Johnson

Medical Claims Processor - Planation

Hollywood, FL - 954-***-****

Seeking a position as Medical Claims Processor in Florida, where I will be able to utilize my skills and qualifications.


Medical Claims Processor

Planation - May 2013 to Present

Process claims forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlement in Raintree system

• Enter claims data into system in Raintree system

• Resolve problems resulting from claim settlement

• Perform audit of randomly selected claims to ensure quality processing

• Download monthly payments for Bank of America

• Follow adjudication policies and procedures to ensure proper payment of claims

• Provide timely customer service to members, providers, billing departments, and other insurance companies on the subject of the claim

• Log telephone calls in systems and follow up on issues

• Authenticate and review information on all medical claims received

• Read and assess medical documents

• Manage and process insurance claims in Raintree system

• Manage claims to be mailed out to the correct insurance company

• Download billing for EKG/ECHO for Northwest, Planation, Westside, University and Aventura Hospitals in HCA system

Shipping/Receiving Coordinator/Front Desk Receptionist/Returns Clerk NationsHealth - Weston, FL - November 2004 to January 2009 Greeted visitors and directed them to the appropriate staff member

• Answered phone and directed call to the appropriate staff member

• Updated returns in the system

• Shipped and packed diabetic medical supplies to Medicare/Medicaid patients EDUCATION

Associate in Medical Office Administration

Florida Career College

April 2013

Diploma in Medical Secretary/Dental Front Office

South Florida Career Institute

July 2009

High School Diploma

East Orange High School - East Orange, NJ



• Over 1 year experience in claims processing

• Front Desk Receptionist

• Highly skilled in coding and processing claims forms for payment ensuring all information is supplied prior to eligible payments being made

• Daily uploading of EKG billing for Northwest, Planation, Westside, University and Aventura hospitals in HCA system

• Monthly uploading of downloads Westside and Planation hospitals in HCA system

• Updating monthly aging claims in Raintree System for Biscayne Echo, Biscayne EKG, Westside to write off Medicaid payments

• Receive and distribute daily mail from USPS, FEDEX and UPS

• Update weekly Biscayne EKG folder

• Process from all hospitals for Face sheets, Diagnoses, Insurance, Insurance cards, Place of Service, EKG/ ECHO Interps in Raintree system

• Update daily claim forms that have old addresses with new face sheets in HCA, Raintree, Memorial, North Broward, and Diagnostic Readers Group systems

• Write off Medicaid claims that insurance will not pay

• Knowledge of generating proper correspondence to ensure compliance of State and Federal regulation policies and procedures

• Able to perform data entry of all interactions

Special Skills and Abilities

• Excellent communication skills

• Outstanding telephone etiquette

• Excellent data entry skills in MS Word, Excel, Email and Internet

• Effective interpersonal skills

• Professional customer service in hectic situations Salary expectation $12 per hour

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