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Medical claims

Location:
Syracuse, NY
Posted:
December 05, 2019

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Resume:

Cindy R Wilson

** ***** ****** #*

Phoenix NY ***35

417-***-****

adaz8a@r.postjobfree.com

Summary

●Professional Medicare Claims Processor and experience with medical claims processing, cob, Medicare secondary payer, etc.

●Successful Medical Claims Examiner with experience as a recalculation specialist and claims trainer.

●Responsible for processing various types of claims including medical, hospital, VNA, and medical equipment.

●Researched claims and request information from providers regarding system issues.

●Processed Medicare Part B Medicare Secondary Payer claims while conforming to the guidelines and quality and production expectations

●Familiar with ICD-9cm, ICD-10cm, CPT-4, and HCPCS coding.

●Worked with coordination of benefits, CMS and Secondary Medicare payment claims.

●Recently retaken a course in HIPPA and blood born diseases.

●Strong data entry skills.

Education

High School Diploma from Edward H. White High School, Jacksonville, FL [Completed]

Registered Medical Assistant from American College of Medical and Dental Careers, Jacksonville, FL, 1986

Skills

●Strengths include organizing, planning and executing projects, sound problem solving skills.

●Proficient with numbers and have a photographic memory.

●Knowledge of using general office equipment, ten key machine, loading, burning and labeling cds.

●Typing speed: 8800 to 8900 KPH

●Microsoft Word, Excel, Outlook, and Power Point.

02/2016 - Have had several surgical procedures and broken bones.

Professional Experience

NGS at Wellpoint Now Anthem, East Syracuse, NY, Medicare B Claims Processor III, 9/2007 - 2/2016

●Processed Medicare Part B Medicare Secondary Payer claims while conforming to the guidelines and quality and production expectations.

●Analyzed and processed claims payment.

●Proficient with multiple surgeries, global, and re bundling claims.

●Trained on and used ecrs system for CMS.

●Worked with coordination of benefits.

●Researched claims and request information from providers regarding system issues.

RMSCO Inc., Liver Pool, NY, Void &Adjustment Coordinator, 9/2006 - 2/2007

●Apply refunds and claim adjustments, while tracking trends for processor, system and provider billing errors.

DataBank IMX, East Syracuse, NY, Production Technician, 5/2005 - 9/2006

●Filming and scanning of corporate documents for the purpose of microfilmed records.

Think Right Now! International, Inc., Camillus, NY, Production and Inventory Control Manager Customer Support, 11/2004 - 3/2005

●Entered customer orders and gave customer support.

●Tracked inventory and production of cd programs and artwork.

●Also did limited work with on-line company affiliates.

Medcom Inc., Jacksonville, FL, Medical Claims Examiner, 04/2003 – 07/2003

●Examined Medical Claims for a third party administrator of company funded Insurance Plans.

Iron Mountain Records Management, Jacksonville, FL, Data Entry Specialist, 2002 – 2003

●Prepared Transmittals

●Impute Data in an all inclusive software program.

Prudential Insurance Company, Jacksonville, FL, Medical Claims Examiner, 1990 – 1998

●Examined Medical Claims, worked as a Recalculation Specialist and Trainer.

●Also worked as a liaison between Member Services and Claims departments.



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