Credit Refund Analyst Claims Handler

VERONICA SIMMONS

Kissimmee, FL ***** C: 754-***-**** ****************@*****.***

Professional Summary

Self-motivated claim handler offering a strong work ethic and determination to complete tasks in a timely manner. Accurate and detail-oriented with extensive bookkeeping and clerical knowledge.

Education and Training

Southern New Hampshire University 2024

Course work in Accounting/Finance

High School Diploma, Medical Secretary 1992

St. Petersburg Vocational Tech St. Petersburg, FL, United Stated

Coursework as Medical Secretary

High School Diploma

Skill Highlights

●Maintains strict confidentiality

●Knowledge of HMOs, Medicare and Medi-Cal

●Managed care contract knowledge

●HIPAA compliance

●Good written communication

●Team player with positive attitude

●Exercises good judgment

●Personal and professional integrity

●Relationship and team building

●Sound decision making

●In-depth claims knowledge

●Claims analysis and review specialist

●Great verbal communication skills

●Good Customer Service skills internal and external

Professional Experience

DHL February 2022 to current-Plantation, FL

Claim Handler

File and manage claims for multiple customers, who use our freight services, either local and internationally, by different modes of transportation. Pursue and collect recovery from all eligible sources, whether from carriers or carrier’s insurance. Provide monthly reporting and recommendation to clients. As recoveries or settlements come in, payments posted to accounts, and are forwarded to Account receivables for processing, to pay customer set to receive payment directly from DHL or checks mailed directly to customers that are set up to receive them.

RemX Staffing- Orlando, FL December 2021 to February 2022

Claim Handler

Enter claims into Riskonnect system to start claim submission to different cargo transport companies due to lost, theft, or damage to or of cargo. Send letters of acknowledgement to vendors and formal claims filed for reimbursement.

Team Leader of Cash Application

Vitas Healthcare Corporation-promoted to position April 2018 to October 2021 Miramar, FL

Run weekly and daily reports to make sure denials posted. Access web portal for different payers to locate EOB of missing from downloaded files to assist with all payments being posted, Scan correspondences received from Medicare are forwarded to Medicare appeal team, Post payment received electronically and manually, posting correction as needed, process an unapplied payment report each month for corporate accountant. Assist collectors with locating EOBS they have trouble finding. Work with reconciliation personal to make sure General ledger is accurate and all write offs, and adjustments have proper signatures. Also assist with EDI enrollment for Vitas so that we are receiving payments and correspondence electronically from payers.

Credit Refund Analyst Apr 2005 - 10/2021

VITAS Healthcare Corporation Miramar, FL

* Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling

Patient information. *

*Thoroughly reviewed remittance codes from EOBS/AR's.

*Completed appeals and filed and submitted claims. *

*Applied payments, adjustments and denials into medical manager system. Remained up-to-date

with all insurance requirements, including the details of patient financial responsibilities, fee-for service

and managed care plans.

*Performed quality control of the data entry system to verify that claims and payments were

posted correctly.

*Submitted refund requests for claims paid in error.*Posted payments, adjustments write-offs.

*Process refund request received by correspondence (mail), fax, or email from insurance companies

or collection agencies

*File dispute or notify insurance of overpayments identified thru daily credit balance reports

Insurance Verification and Collector Jan 1999 to Feb 2003

U.S. Diagnostic West Palm Beach, FL

*Handle Customer Service call from patient wanting to know if insurance verification was

complete.

*Handle Outgoing call to insurance companies to verify patient coverage and benefits for X-rays,

MRI'S, CAT Scans and other radiological procedures.

*Placed outgoing call to follow-up on claim status, payments or reason for denials

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