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Elsie Dougi

**** * **** **

Phoenix, AZ 85016

acxo3p@r.postjobfree.com

Phone Number: 480-372- 7177

Home Number: 602-840- 3746

Skill Summary

I have over 15 years of medical claim experience. Displays sensitivity,

integrity, compassion and respect towards patients and family members.

Adheres to HIPPA/OSHA regulations and to company privacy standards;

protects patient confidentiality. Medical terminology, IDC9 & CPT coding,

research data, Process UB92 and HFCA claims, read solar Installation blue

prints and complete job packets. Microsoft Word, Statistics reports, Quattro

Pro, Windows, Excel, Lotus Spreadsheet, Basic Internet, PowerPoint and Basic

Bookkeeping.

Work Experience

Encounters Specialist

Aetna-Mercy Care Encounters Unit, Phoenix AZ, 06/2013 - 07/22/2016

Working encounter/claims edits for state of AZ. Working directly with PMMIS,

QNXT and EMS, Pend Analyzer systems to resolve all state edit errors

rejections.

Data Entry Operator

Apple One Temporary Service, AZ Dept. of Revenue, Phoenix, AZ from:

03/29/2013 to 05/31/2013 Process incoming checks and documents for

different tax year and quarter. Validate checks and make sure the document

matches by account, tax ID and names. Enter data for other documents as

assigned.

Claims Processor

Health Choice AZ, Phoenix, AZ from: 07/2006 to 07/2012

Reviewed & entered claims ensuring that required information

documentation was submitted for proper adjudication. Performed system

research as appropriate for facilitate payment accuracy. Payment, accuracy

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and production exceed 95% of Health Choice requirements. I processed HCFA

and Outpatient UB92 claims.

Claims Adjuster

INC/Temp Service United Healthcare, Phoenix, AZ from: 09/2004 to 11/2004

Adjusting HCFA claims reissued and reversed claims. Provided stock check

returns. Research claims payment to make sure the correct provider was paid

correctly. Additional duties included update data in customer service

department using excel spreadsheet. Faxed claim information to providers.

Data Entry Clerk

Nova Care Rehabilitation, Phoenix, AZ from: 03/2001 to 11/2001

Enter daily expenditures and statistics from other clinics to updated reports

using excel spreadsheet. Managed daily sign in for patient’s medical records

on file. Tracked payments on HFCA claims with correct procedures &

diagnostics codes.

Claims Examiner I

Mercy Care Plan, Southwest Catholic Health Network Phoenix, AZ from:

03/1998 to 01/2000

Reviewed & entered claims ensuring that required information

documentation was submitted for proper adjudication. Performed system

research as appropriate to facilitate payment accuracy. Coordinate benefits &

calculate payment accordance with AHCCCS policy. Maintain accuracy of

claims processed by meeting the established audit standards 99% financial

and 98% statistical. Processed HFCA claims forms production standard of 100

or 95 online per day. Utilized authorizations follow up before paying these

claims if needed. Process paper claims 300 per day, clean claims and batch

claims 238 per day. I processed 166 pended claims and about 15 to 25 UB92

Hospital claim forms per day.

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Education

*Maricopa Skills Center, A Division of Gateway

Comm College PHX AZ 1996-1997

Vocational Certificate or Credential Micro-computer

*Mountain States Technical Institute,

1990-1991 Certificate in Vocational Word Processing

*Salt Lake Community College Salt Lake City UT

1989-1990

Major in Nursing Assistant/Aide and Patient Care Assistant

Some College courses credit received.

*Rough Rock High School Rough Rock, AZ

1987- 1988 Received GED

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