Insurance Claims Billing Specialist
Resume:
Robin Lundy
Minneapolis, MN *****
ad35qs@r.postjobfree.com
OBJECTIVE: I am seeking employment in medical insurance claims billing through the continued utilization of my skill set in the examination, adjudication and processing of insurance claims.
RELEVANT EMPLOYMENT:
Billing Claims Specialist, CVS/Coram, Inc., August 2018 – July 2022.
PRIMARY JOB DUTIES AND RESPONSIBILITIES:
Coordinated the billing of patients with insurance payers that have unique qualifications and filling requirements for National Council for Prescription Drug Programs (NCPDP) - related claims.
•Ensured the successful adjudication of prescription drug dispenses for payer claim approval prior to the delivery of the medication to the patient.
•Assisted other Pharmaceutical and Medical Billers and in the facilitating of payer overrides of denied claims.
•Performed the billing of medications and related services as required for each subsequent dispense of medication as required by payer requirements.
•Maintained the medical record in Enhanced Care Management (ECM) with scanning results of each adjudication performed into a PDF file, and in Health Care Notes (HCN360) through entries in the progress notes of the patient.
RELATED EMPLOYMENT:
Nursing Home Billing Specialist, Northwest Respiratory Service (temporary assignment) November 2023- February 2024.
Created monthly invoices on durable medical equipment rentals to nursing homes and hospices.
Calculated credit adjustments for reimbursements on patient and facility accounts.
Medical Insurance Claims Customer Service Representative, Alorica, Inc. August 2013 – May 2018.
Assisted pharmacies in processing claims.
Assisted customers seeking enrollment information on health insurance policies offered in state-run health insurance exchanges.
SOFTWARE UTILIZED:
Citrix, HCN360, CE2000, Epic, Health Notes, ECM, MSWord and Excel, Sales Force, SAP.
EDUCATION:
Bachelor of Arts, Minnesota State University.
Concentrated of Study: Accounting, Health Information Systems, CPT and ICD Medical Coding, Human Anatomy and Physiology.
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