Barbara Casey-Coverson

Dallas, TX *****

ad2fbc@r.postjobfree.com

+1-817-***-****

Work Experience

Medical Claims Examiner

Allyhealth Solutions, INC - Dallas, TX

May 2021 to Present

Performs collection activities, such as monitoring delinquent accounts, payment recouped, resolving billing denials, and answering routine inquiries. Verification of multiple major payers and other miscellaneous Insurance collection accounts to ensure that all payments are accounted for and properly posted. Documents all claims detail received either via phone calls, fax’s and paper/ electronic EOB, on a consistent basis. Resolves issues that created a denial within 5 days of receipt of denial. Maintains a thorough understanding of Texas and California Medical Clinic/Hospital Contracts, In/Out of Network Status, NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies. Claims Billing Specialist

UnitedHealth Group - Irving, TX

February 2020 to October 2020

Review claims for processing research any denials, solve and reprocess any new assigned claims. Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool). Independently complete on a daily basis all documentation and communicate the status of claims as needed adhering to all reporting requirements.

LOA Leave of Absent Rep

Sedgwick - Irving, TX

March 2019 to February 2020

To analyze reported Family Medical Leave (FMLA) requests; to make determinations based on state and federal regulations; and to ensure that on-going claim management is within company service standards and industry best practices. Establishes FMLA claims; tracks and codes documentation in accordance with internal workflow processes. Analyzes FMLA claims to determine eligibility and certification in compliance with state and federal regulations. Identifies action plan; determines benefits due; and makes timely case decisions based on service expectations as established by the client. Communicates decisions and on-going expectations with claimants and clients

Public Adjuster

Dimont & Associates - Dallas, TX

May 2018 to March 2019

Research and verify insurance policy coverage, Present auto repossession claims to insurance companies. Investigate claims by examining photograph, reviewing any recorded statements, and obtaining all other documentation related to the claim(s) and/or prior claims. Negotiate with insurance companies on settlement amount for damages. Dispute denials with tow truck affidavit, purchase agreement and declaration page

Catastrophe Desk Adjuster

Global Risk Solution Temp, Deployment to FL - Sarasota, FL October 2017 to December 2017 (CONTRACT

Contact insured after being assigned claims, Interprets and applies policy coverage to loss, communicates policy coverage and benefits to insured. Creates, reviews, and approves estimates for the cost of repairs or replacement of damaged or destroyed property. Properly documents claim files with all activities and submits final report to file for closure. Determines or declines payment and issues check as required. Negotiates with insured, contractors, vendors, public adjusters and attorneys when necessary. Identifies and investigates questionable and possible fraudulent activity. Closure of five to seven claims daily, with a caseload of 50-75 claims

Education

High school diploma

Tenaha Schools - Texas

Skills

• EMR Systems- 5 years

• Time management (WC/FMLA/STD)- 2years

• Microsoft Excel- 15 years

• Medical Terminology- 15 years

• Epic (10+ years)

• EHR systems (1 year)

• Workers' Compensation

• Xactimate (4 years)

• CAT Property Adjuster (2 years)

• Desk Auto/Property intake (6 years)

• Payment negotiation- HO/Auto/Medical (5 years)

Certifications and Licenses

Property & Casualty Insurance Adjuster

October 2023 to February 2025

Texas- 1954677

Status: Active

Effective date: 10/4/23-02/16/25

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