Medical Records

PROFILE

Madison native with extensive background in the health & life insurance industry seeking full time, challenging long-term career with a reputable company. Expert in health and life claims, underwriting, medical terminology, contracts and client care. Experience with ICD, CPT and HCPCS codes. Excellent negotiator and mediator. Familiar with insurance and contract law at both the state and federal level, responding to complaints and phone depositions. I enjoy the challenge of any legal or contractual issues that need research to resolve. Proficient with multiple tech programs and platforms.

EXPERIENCE

REAL ESTATE BROKER 2013 - PRESENT

I’m currently a REALTOR®/Broker for Century 21 Affiliated in Madison, Wisconsin. In this position, I am presented with new situations daily, new clients, & frequent phone/email correspondence from current and potential clients. In addition I have gained experience with contracts and state real estate law. This is a part-time flexible position.

NATIONAL GUARDIAN LIFE 2009 TO 2013

I began as a claims rep for life policies where I approved or denied benefits for decedents based on contract language of over 20 policy types. Determined correct beneficiary for claims. Paid claims based on company guidelines, contract language and within the legal time-frame. I assisted in training new associates and reviewing claims for accuracy. In 2010 I was promoted to underwriter, where I requested and reviewed medical records to verify if the policy was payable based on medical history and medical conditions disclosed on the application. Approved or denied disability claims based on medical and contractual guidelines. I also requested and reviewed medical records to determine if lapsed disability policies qualified for reinstatement. I prepared detailed denial letters based on my medical or contractual findings. I answered calls from relatives of the decedent to update on status and explain denials.

STATE OF WISCONSIN DISABILITY DETERMINATION BUREAU 2005 TO 2009

In this position I was a first level disability claims processor. Daily activities involved requesting and reviewing medical records, interviewing the claimants, their physicians, social workers, & law enforcement agencies. After interviewing and reading medical records, I used the social security guidelines as well as work history and educational background to determine if a claimant was approved for social security disability and on occasion Medicaid. Extensive classroom training was provided by physicians in the fields of cardiology, mental heath, musculoskeletal systems, respiratory systems, digestive systems, hematological, congenital disorders and endocrine disorders. I managed a case load of approximately 100-125 cases, and consistently met legal timeframes for responding and processing of applications.

EDUCATION

MADISON COLLEGE - 2001

Paralegal Certification

CONCORDIA UNIVERSITY - 2003 - 2007

Completed 30 credits towards my bachelors degree in Criminal Justice / Pre-Law. GPA of 3.8. A few core classes completed include: Research Methods, Finance & Budgeting, Forensics, Investigation, Constitutional Law and Law Enforcement Agency Management.

SKILLS

•Medical terminology

•Client services

•Contracts

•Negotiations

•Medical and life claims

•Medical & legal terminology

•Medical coding including HCPCS, ICD & CPT.

•Medical records review

•Medical disorders / diseases

•Interaction with physicians, social workers & law enforcement

•Clerical activities

SKILLS

•Professional

•Self-Motivated

•Precise communication

•Negotiator

•Best under pressure

•Strong work ethic

•Able to adapt to frequent change

•Critical thinker

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