Customer Service Claims Adjuster
Resume:
OUIDA C. UNDERWOOD
BIRMINGHAM, ALA 35235
*********@***.***
EDUCATION
AIU University 2010 – 2011
Chicago, IL.
Healthcare Management
C.A. Fred’s Tech School 1976 - 1977
Tuscaloosa, Ala.
Business
Lew Wallace High 1972 - 1976
Gary, Ind.
Academics
EXPERIENCE
Viva Health 2011 - 2019
Birmingham, Ala.
Q.A. Specialist
Trains/reviews Commercial, Medicare and Drummond claim staff to include entry/adjudication for accuracy based on Viva Health’s Certificates of Coverage, regulatory/compliance guidelines, all Policies and Procedures. Documents and distributes error findings to Claims Supervisor for review and to educate staff on claims payments issues. Reconcile/provides bi-weekly and monthly quality assurance summaries to include individual and departmental errors, claims productions and other findings. Investigates claim submissions for coding inaccuracies and provide feedback to CFO to help with overall cost savings. Maintain confidentiality in regards to individual error results.
Benefits Configuration, test newly implemented benefit packages prior to going live to ensure all benefits, deductibles, co-payments and co-insurances are applying correctly
Viva Health 1998 – 2011
Birmingham Ala.
Claims Adjuster
Provide customer service to providers and members concerning claims
review paper claims, HCFA’s and UB92 for accuracy in entering data,
for claim types, CPT-4, ICD-9, HCPCS codes and provider information before
processing claims for payments or denials, Review electronic claims for accuracy in member demographics, REVENUE, ICD-9 and CPT codes before making payments or denials, co-ordinate benefits with Medicare, Medicaid and other insurance companies, maintain departmental production and quality goals, follow up and research pended claims to assure the turn-around time frames are met, read, understand and apply appropriate claims policies and procedures that relate to the adjudication of claims
.
Strategic, Inc 1997 - 1998
Birmingham, Ala
Claims Adjuster
Review all provider claims, HCFA’s and UB92, process for payments, review checks before mailing to providers
MedPartners 1995 - 1997
Birmingham, Ala
Customer Service/Insurance F/U
Review ledger, find all accounts 15 – 30 days old, call insurance companies or
patients to request payments, print and file HCFA or UB92
Lloyd Noland Hospital 1993 - 1995
Birmingham, Ala.
Patient Accts. Rep
Review account ledger for unpaid balances, call providers or patients to collect
payments, mail collections or promissory letters to patients, pull medical records and mail to insurance companies as requested
Provident Life 1979 - 1992
Birmingham, Ala.
Claims Adjuster
Provide customer service to providers and members, process claims for payments or
denials, mail out letters to request info about accidents, workman’s comp, cob
and subrogation
SKILLS Customer Service, Medical Terminology, Coding Workshop, Microsoft Word,
AS 400, Typing, Faxing, Adding Machine, Copier
REFERENCES AVAILABLE UPON REQUEST
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