Medical Claims Health Advocate

MARY Heydt

Health Advocate at Foundever (formerly

Sykes)

*********************@*****.***

412-***-****

Lehighton, PA

Work Experience

Health Advocate

Foundever (formerly Sykes)

December 2012 - Present

• Provide expert assistance to customers in selecting health-related products and guide them to suitable healthcare solutions.

• Efficiently manage customer orders, cancellations, and inquiries to ensure a seamless experience.

• Advocate for customer needs by offering personalized healthcare guidance and support. Medical Claims Processor

Prudential

January 1990 - December 2004

• Processed medical claims and determined payment or denial for Blue Cross spin-offs.

• Applied knowledge of CPT and ICD9 codes to assess claims accurately.

• Promoted to Medical Claims Examiner due to proficiency and accuracy in claims processing. Medical Claims Examiner

Prudential

January 2005

• Evaluated operative reports in both Latin and English to ensure compliance and accuracy in surgical procedures.

• Determined payment or denial of claims based on comprehensive analysis of medical reports and adherence to guidelines.

• Acquired an in-depth understanding of various medical surgeries and their methodologies.

• Learned and utilized medical terminology along with CPT and ICD9 coding effectively.

• Managed a daily quota of evaluations, maintaining high accuracy and productivity levels. Education

Northampton Community College

GED

• Bethlehem, PA

Skills

Claims Evaluation Customer Service Order Management Healthcare Guidance Time Management Compliance and Accuracy Surgical Procedures Knowledge CPTICD9 Coding Problem-solving Medical Terminology Communication Attention to Detail

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