Data Entry Customer Service

SHATARA FORNEY

*************@*****.*** 903-***-**** Lufkin, United States 75901

Summary

Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Skills

Data Entry

Customer Service

New Policies Processing

Eligibility Determination

Information Verification

Experience

Cognizant Technologies Solutions Teaneck, NJ

Medical Claims Processor

10/2021 - 06/2023

Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.

Reviewed claims for accuracy before submitting for billing.

Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.

Evaluated pending claims to identify and resolve problems blocking auto-adjudication.

Verified claim data correctness in preparation for processing.

Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.

Reviewed history records to determine benefit eligibility for services.

Cigna-HealthSpring

Medical Coder

04/2017 - 10/2020

Maintain 95% accuracy and completeness on all charts as well as meeting 6-8 CPH

Follows CMS risk adjustment guidelines and has a complete understanding of the guidelines.

Review patient encounters to determine the appropriate ICD-10 codes as supported by the provider's documentation, verifying the record abstracted is for the noted member and claim, verifying the claim is for a valid risk adjustment service.

Maintained high accuracy rate on daily production of completed reviews.

Comprehensive Sleep Medicine Associates

Medical Biller and Coder

01/2016 - 02/2017

Process and code claims within a timely matter for all commercial insurances as well as Medicare/Medicaid?Workers Comp.

Verified insurance coverage, processed and prepared patient refunds, answered and explained any questions to patients regarding insurance coverage and how claims were paid.

Received prior authorization when needed for procedures, filled out predetermined forms for needed, scheduled patients.

Reviewed medical records to meet insurance company requirements.

Documented and filed patient data and medical records.

Memorial Medical Center

IP/OP Charge Capture

12/2014 - 01/2016

Accurately submitted selection of ICD-9 CM and CPT procedure codes based on EMR to the highest degree of specificity and level of diagnostic work up based on medical records.

Performed line item charge reviews using patient enhanced encounters, assure accuracy of charges captured for insurance and patient billing for both IP/OP services.

Validated documentation on all diagnosis codes in chart to capture HCC's

Education and Training

Blinn College Brenham, TX

Major: Registered Health Information Technology

Courses Completed: Anatomy & Physiology 1&2, Medical Terminology, Coding and Classification, Computer Systems for Health Information Technology, Legal and Ethical Aspects of HIM, Human Diseases and Conditions, Methodology

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