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Customer Service Data Entry

Peoria, Arizona, United States
October 23, 2016

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Tonya S Kahler


Professional Summary:

Reliable, hard-working, dedicated professional seeks a long-term Claims Processing position where my skills and abilities can be utilized to their fullest extent. I have the ability to make independent decisions quickly and accurately. I am also proficient in processing Medical and UB claims. As you will see from my work history below, I am able to work independently in a fast paced environment while maintaining a high level of performance.

Proven Skills/ Knowledge:

Extensive Processing Background

Solid communication Skills

Proven problem solving

Strong Organizational Skills

Excellent multi-tasking skills

Proficient in COB

flexible/ adaptable

Willingness to learn new tasks


CPT, HCPCS, Revenue Codes, ICD-9/10

ability to work under pressure

Experience in fast paced environment

Professional Experience:

Care1st Health Plan Arizona 3/2015 – Present

Claims Analyst II

Accurately review claims for billing accuracy, including CPT, HCPC, ICD-9/ICD-10, according to standard billing guidelines

Adjudicate claims in accordance based on policy guidelines to ensure accurate reimbursement to the provider, manually applying the appropriate benefits and maximums

Research and analyze complex claims (including COB, resubmissions, etc.), manually applying deductible, coinsurance and copayments as necessary

Perform reversals/ adjustments accurately as needed

Met production and quality goals, as well as project deadlines

Chosen to stay on to assist the California office on SNF claims and adjustments following the TPA wind-down following the loss of the Meritus business

Cognizant 12/2011 – 2/2015

Claims Processing Specialist

Accurately adjudicated Medical and Hospital Medicaid claims for multiple states (South Carolina, Utah, and Washington)

Handled Professional, DME, RX, Home Health, Physical & Occupational Therapy, Inpatient and Outpatient UB-04 claims

Accurately adjudicated claims in accordance with the provider contracts, verifying authorization requirements

Coordinated benefits with primary Commercial or Medicare coverage

Adjusted claims for underpayments, overpayments, and corrected billings

Insurers Administrative Corporation (IAC) 06/1997 – 4/2011

Claims Processor

Processed Medical, Dental, and UB claims with a high level of accuracy

Negotiated discounts on high dollar medical claims

Performed claim adjustments as necessary

Responsible for 10+ individuals to backup the Supervisor, answering questions as needed

Assisted data entry when inventory levels rose

Provided outstanding customer service, answering questions on benefits/ adjudication

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