Claims Analyst, data entry, healthcare administration
Resume:
Crystal Kane
Youngstown, OH *****
**********@*****.***
Highly-motivated employee with a desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Skilled in working under pressure and known for leveraging analytical thinking and creativity to solve problems and deliver high-impact solutions in fast-paced environments.
Authorized to work in the US for any employer
Work Experience
Customer Service Associate 1
Ohio Department of Job and Family Services-Akron, OH June 2024 to July 2024
• Answered phone calls from customers promptly and courteously.
• Escalated unresolved customer issues to the appropriate department or manager for resolution.
• Demonstrated active listening skills when responding to customer questions and complaints.
• Provided information about services available to customers such as online access for customer accounts based on individuals needs.
• Followed-up with customers after weekly or biweekly claim filings to ensure satisfaction.
• Managed multiple tasks simultaneously while maintaining accuracy and attention to detail.
• Resolve customer inquiries in a timely manner via phone, email and chat messages. PTAC Central Unit Rep Remote WFH
Parallon /HCA Healthcare-Remote
October 2021 to September 2023
Responsible for multiple forms of patient pre registration
• online OPR Tool (patient portal pre registration).
• Pre register patients from the physicians order received, or utilize an account within the last 60 days if there is no physician order on file at the time.
• Insurance verification.
• Run Medical necessity for any Medicare /Managed Medicare accounts.
• Call the ordering physician office if there are any DX code/s / CPT code updates needed to pass Medical Necessity.
• Obtain customer out-of-pocket expense quotes per their individual health carrier policy. Team Lead Government Collections -Medicaid
Parallon- Orange Park SSC-Orange Park, FL
May 2018 to October 2021
Managed Medicaid TL- responsible for coordinating day-to-day activities for the Managed Medicaid Collections team operations.
• Pool monitoring for daily inventory completion.
• Reviewing accounts for correct work follow up.
• Assist Manager as needed.
• Beginning and Month End coding.
• Prepare info for Team Weekly Huddle meetings.
• Review and approve team adjustment lines in Etran daily.
• Weekly Payer JOC calls for escalation.
• Send Time cards biweekly to team for approval.
• Prepare manager one on one sheets for review.
• Assist team with any questions, concerns, and/or training needed.
• Work all mandatory reports by deadlines.
• Time management/ prioritize proactively.
Experience in Artiva, Continuity, Payer webs, Onbase, HPF, Microsoft Word/ Excel, Kronos, AR Tool Top Dollar Collections Specialist
Parallon- Orange Park SSC-Remote
August 2015 to May 2018
Responsible for performing account follow-up and resolution of insurance and patient receivables over
$25,000.00 expected reimbursement.
• Work TOP Dollar Insurance pools to resolve claims for payment.
• Review EOB's, remits, and payer correspondence to accurately work accounts and escalate if necessary.
• Identify/escalate accounts to management.
• Maintain productivity and QA standards.
• Properly and efficiently document patient accounts.
• Extremely knowledgeable with multiple insurance payers: Medicaid, HMO/PPO, Misc Commercial, Auto, Managed Medicaid/Medicare, VA, Hospice.
Experience in Artiva, Continuity, Payer webs, Onbase, HPF, Microsoft Word/ Excel Claims Resolution Specialist II
Parallon Business Solutions, Inc-Youngstown, OH
March 2014 to August 2015
Work claims from billing to payment.
• Follow up with Commercial Insurance carriers /patients as needed.
• Appeal denials (medical necessity, no authorization, etc.).
• Access Medical Records, Claims, and Remits.
• Actively worked Ohio Medicaid Recoupment Projects & Reclaim Reports. Experience on STAR, GPS, Excel, Word, Epremis, Artiva. Office Manager / Payroll administrator / HR manager / Accounts Payable & Receivable / Freight Coordinator / Inventory Control Warrior Imports Inc dba Starr Wheel Group-North Jackson, OH November 2007 to May 2013
• Paychex Payroll Service weekly.
• Quarterly Payroll Taxes.
• Interview new hire candidates.
• Accounts Payable & Receivable for Ohio office.
• Use of QuickBooks accounting software.
• Monthly reporting to company accountant.
• Collection of all aging A/R accounts.
• Bi-annual sales tax reporting.
• Track outgoing LC payments.
• Schedule out-going and incoming freight daily.
• Entering POs.
• Create new part numbers.
• Inventory reports.
• Invoice daily paperwork.
• Answer phones for sales department.
• Use of TCS software.
• Negotiate, Enroll, terminate, and distribution of Health Insurance and 401K benefits.
• Order supplies for office and Warehouse.
.
Payroll Administrator / HR Manager / Accounts Payable / Executive Assistant Player Wire Wheel dba B&R Wholesale Tire-Youngstown, OH February 2001 to November 2007
• ADP Payroll Services for weekly payroll 70+ employees.
• Negotiate, enroll, terminate, and distribution of health insurance and 401k Benefits.
• Payables for Player Wire Wheel and B&R Wholesale Tire.
• Vendor maintenance.
• Use of AS400, Microsoft Word, Excel, Peachtree Accounting software.
• Track all upcoming import containers LCs.
• Run end of month/year end reports.
• Daily deposits.
• Travel Coordinator for company functions and outside sales visits; including arrangement of hotels and transportation in states and international.
• Office supplies for all departments.
Education
Diploma
WESTERN RESERVE HIGH SCHOOL - Berlin Center, OH
September 1992 to June 1996
Skills
• Human Resources Management
• Kronos
• Paychex
• Payroll
• Personal Assistant Experience
• QuickBooks
• Microsoft Word
• Microsoft Powerpoint
• Microsoft Outlook
• Time Management
• General Ledger Reconciliation
• Tax Experience
• Computer Skills
• Accounts Receivable
• Accounts Payable
• Office Management
• Bank Reconciliation
• Journal Entries
• Medical Billing audits (5 years)
• Benefits Administration
• Microsoft Excel
• Interviewing
• Data collection
• Medicare
• Analysis skills
• Communication skills
• Editing
• ADP
• Organizational skills
• Writing skills
• Customer service
• Phone etiquette
• Documentation review
• Typing
• Microsoft Office
• CPT coding
• ICD-10
• Medical Billing
• Event Planning
• Pricing
• Epic
• Workers' Compensation
• Account Reconciliation
• Medical billing edits (4 years)
• Contract negotiation (10+ years)
• Schedule management (10+ years)
Awards
National honors society
June 1996
Certifications and Licenses
Driver's License
July 2023 to July 2027
Assessments
Medical billing — Proficient
October 2023
Understanding the procedures and forms used for medical billing Full results: Proficient
Protecting patient privacy — Proficient
October 2023
Understanding privacy rules and regulations associated with patient records Full results: Proficient
Spreadsheets with Microsoft Excel — Proficient
October 2023
Knowledge of various Microsoft Excel features, functions, and formulas Full results: Proficient
Attention to detail — Proficient
October 2023
Identifying differences in materials, following instructions, and detecting details among distracting information
Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
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