Tonya S Kahler
acw6uh@r.postjobfree.com
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
Dedicated
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