Irish Williams

Thomasville, GA *****

ad1oe6@r.postjobfree.com

+1-229-***-****

Motivated and resourceful professional with a reputation for quality, proficiency, and reliability seeking to transition medical education to the healthcare industry. AA Degree in Healthcare Management.

• Proficiencies: Greenway; MS Excel; MS Word; Typing Speed: 50 WPM

• Skills: Written and verbal communication (letters, emails, presentations, face-to-face communications); Problem solving skills; Attention to detail; Team player; Trustworthy Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Claims Processor

Creative Solutions in Healthcare

August 2022 to Present

• Research and adjudication to correctly apply benefit determinations on routine uncomplicated medical claims (CMS 1500 and UB04) and Rx claims in accordance with claim processing guidelines,

• Pends claims as directed by departmental policies and procedures, follows up for resolution and process pended claims immediately following a benefit / payment determination.

• Works claims inventory from assigned queues to ensure all claims process within established turnaround time as directed by department.

• Review claim submissions, obtain and verify information, correspond with insurance agents and beneficiaries, and process claim payments.

CSR/Claims Representative

CNSi - Tallahassee, FL

August 2021 to June 2022

• Answer incoming calls from customers.

• Assist customers with requests for information, complaints, making appointments, and resolving issues.

• Answering telephonic and e-mail inquiries in a timely manner.

• Examine and resolve medical claims, documenting claims, and ensuring that all claims are processed within company and legal guidelines.

Claims Processor

CNSI- Tallahasse, FL

April 2020 to January 2021

* Analyze insurance information.

* Perform data entry for all claims

* Decide whether a claim should be processed or denied. Administrative Assistant/Secretary

Gene Price LLC - Thomasville, GA

September 2019 to April 2020

* Help members with there medicare Insurance by going over there copay and benefits.

* Data Entry, Microsoft Excel, PowerPoint, and Word

* Provided great customer service skills when members came into office. Medical Insurance Specialist

Aetna - Tallahassee, FL

October 2018 to July 2019

Customer Service Representative

* Examine the claims and verify insurance eligibility.

* Take payments for monthly premium for medicare insurance.

* Enroll members in healthcare insurance.

Healthcare Claims Specialist

DXC Technology - Tallahassee, FL

January 2016 to May 2018

* Investigate claims and obtain relevant facts to determine coverage, loss and liability.

* Interact effectively with customers, insurance agents, police, attorney and other public personnel involved in claim process.

* Resolve claim issues promptly and follow-up on outstanding issues. Education

Associate of Science degree in Management

Ultimate Medical Academy

2020

Skills

• Healthcare Ethics

• HIPAA Compliance

• Accounting

• Payroll

• Appointment Scheduling

• Insurance Verification

• CMS 1500

• Processing Co-Payments

• UB-04

• Greenway Prime Suite

• Insurance Billing Procedures

• Insurance Claim Cycle

• Medical Terminology

• Electronic Health Records (EHR)

• Electronic Medical Records (EMR)

• Health Records Management

• Medical Records Management

• Human Resource Management

• Organizational Improvements

• Interpersonal Professional Communications

• Medical Office Experience

• ICD-10

• Medical Scheduling

• HCPCS

• OSHA

• Windows

• Customer service

• Microsoft Excel

• Microsoft Word

• Microsoft Powerpoint

• Microsoft Outlook

• Medical Coding

• Anatomy Knowledge

Assessments

Customer focus & orientation — Highly Proficient

October 2019

Responding to customer situations with sensitivity. Full results: Highly Proficient

Attention to detail — Familiar

October 2019

Identifying differences in materials, following instructions, and detecting details among distracting information.

Full results: Familiar

Customer service fit — Proficient

July 2019

Assesses personality traits that result in high-quality customer service. Full results: Proficient

Filing & organization — Familiar

July 2019

Arranging and managing information or materials using a set of rules. Full results: Familiar

Written communication — Familiar

May 2019

Measures a candidate's ability to convey written information using proper grammar rules. Full results: Familiar

Work style: Reliability — Completed

October 2019

Tendency to be dependable and come to work

Full results: Completed

Electronic health records: Best practices — Completed October 2019

Knowledge of EMR data, associated privacy regulations, and best practices for EMR use. Full results: Completed

Verbal communication — Proficient

May 2019

Measures a candidate's ability to effectively convey information when speaking. Full results: Proficient

Call center customer service — Proficient

October 2019

Applying customer service skills in a call center setting. Full results: Proficient

Basic computer skills: PC — Completed

October 2019

Performing basic computer operations, navigating a Windows OS, and troubleshooting common computer problems.

Full results: Completed

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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