CYNTHIA HOPKINS

**** ****** **. ****** **** IL **477

708-***-**** ad3wbi@r.postjobfree.com

Professional Summary

Medical Claims Auditor / Adjudicator, years of experience in HMO, PPO ERISA, LIFE and DISABILITY claims, Commercial, Private and Union medical claims processor. Actively pursuing a degree in Health Information Administration. PROFESSIONAL HISTORY

INSURANCE RECOVERY SPECIALIST: LOYOLA HOSPITAL 08/05/2019 CURRENT, NATIONWIDE COLLECTION

Review online claims, Resolve: claims EOB & COB rejections error’s, Utilizing online web application

EPIC, ONE SOURCE, AVAILITY ETC ) Appeal claim Denials, Calls to Insurance co. for claims resolutions

Providers, Subscribers CMS 1500 Error review, Payment recoupement and corrections. REMOTE / WITH HIGH INTERNET SPEED.

Claims Processor 01/2010 to 10/2013 Chamberlin Edmonds

Scan, Fax, File, and update Notes, on all Mail,Faxes, and courier mail, For Stroger Oak Chicago, IL Forest, Rush, Provident, and Northwestern Hospitals.

Distribute mail to over 20 RAS consultants.

Maintain files for all State and Federal applications. ie SSI Medicaid Medicare

Research Assist managers with verifications .Create Spread sheets and distribute to Manage Team Leaders

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Claims Auditor contract 11/2007 to 03/2009 Destiny Health-care

Investigate claims errors and open claims, Corrections, check reissue, adjust Accumulators. Chicago, il Carefully reviewed medical records for accuracy and completion as required by insurance companies. Thoroughly investigated past due invoices and minimized number of unpaid accounts.

Customer Service

01/2007 to 11/2007 Anthem Blue Cross/Blue Shield Contract

Customer Service REP, trained in Mason Ohio, assigned to Indianapolis IN. Chicago, IL servicing over 65 calls a day, maintaining scheduled adherence of 99.82% daily, loading caller intakes, corrections, billing, underwriting, address updates, trained on FACETS, ULTERA, HYPERION, AMMS, GENESYS, TANGIBLES COSMO, PEOPLE SOFT., Also posting and updating Pay By Phone.

Blue Access/ Blue Preferred, Traditional products. Strictly followed all federal and state guidelines for release of information.

Sr. Claims Adjudicator 01/1997 to 01/2006 Carpenters Health & Welfare Fund Chicago

Compute manual and electronic health claims according to ERISA and Health & Welfare Chicago, IL provisions. For Hospitals, Physician's and all ancillary providers /Surgery CTR. Adjustments, refunds, coordinate benefits, EOB's Strictly followed all federal and state guidelines for release of information. Assist applicants with Pension benefits and consultations. Processed and monitored Disability and Life insurance benefits. Liaison between Chicago and Geneva IL. offices.

Claims Adjudicator / Customer Service 01/1995 to 01/1997 United Chambers

Adjudicate Medical claims for large and small groups. Naperville, IL

Interpreted Benefit inclusion and exclusions, to Membership and Providers, HMO, PPO and EPO plan.

System updates of Deductibles, out-of pockets, COB'S Corrections and calculations of benefits. Over

30 benefit Packages. Mandatory production 80 claims per day. Call volume 60 calls per day

Medical Claims Processor 01/1993 to 01/1995 Auto Mechanics Local 701

Claims Adjudicator / CUSTOMER SERVICE REP, Health & Welfare, Processed Hospital Chicago, IL Physicians and all ancillary charges according to benefit provisions. Using the Quic Claims System.

processed Deductibles, out of-pockets, and Benefit Maximums

Correspondence with providers, remedied all complaints and over-and under payments of claims. Productions of 100 claims daily.

Project Associate

01/1992 to 01/1993 American Health Information AHIMA

Project Associate /abstracting medical records for the National Maternal and Infant Health Chicago, IL Survey of 1988

Requesting and receiving Medical records from hospitals throughout united States Abstracting information related to Mother and infant survey. Updating coding requests.

Reference Material used ICD-9-CM, CPT-4, Drug Handbook, and Taber's Medical Dictionary.

Education and Training

Health Information CCS coder

Moraine Valley community College

EDUCATION: Health Information Palos Heights, IL, united States

Medical Terminology Anatomy,Pharmacology, ICD/CPT Health Information management, Computer Allied Health

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