Medical Claims Examiner
Resume:
TinaMarie Chartrand
Niagara Falls, NY 14304
************@***.***
Summary
With over 20 years of experience, my skills vary from processing claims for insurance companies and TPA’s to billing for a doctor’s office and surgical facility. Dean Vaughn medical terminology trained. Full knowledge of CPT, HCPC, ICD-9 and ICD-10. Experience with UB04 and CMS1500 forms. Knowledge of HMO, PPO, Medicare & Medicaid. Experienced with pre-existing conditions, subrogation, physician liens, cost management, fee negotiation and preferred provider organization networks. Experience billing from operative reports, radiology reports and chart notes. Management experience in billing department. Proficient in Microsoft Outlook, Work and Excel.
Education
Tampa College Graduate – Certified Medical Assistant
Seminole High School Graduate
Systems
Rims, Trizetto, Diamond, Eldorado and Parallon
Experience
2019 – 2020
ASM Research
Duties: Call center contracted with the Federal Department of Education. Assisted students and parents with applying for federal student loans and maintaining existing loans.
2013 - 2017
Xerox
Hunt Valley, MD
Recovery Analyst
Duties: Contracted locally in the Tampa Bay area with various insurance companies to audit claims paid to recover overpayments.
2011 – 2012
Coordinated Benefit Plans
Clearwater, FL
Claims Analyst
Duties: Processed claims for short term medical plans as well as high volume customer service calls for multiple plans. Processed health, dental and death claims.
2007 – 2011
ADM Medical Supplies
Seminole, FL
Director of Operations
Duties: Oversaw office staff of 8 including 60 outside sales reps. Handled all payroll and reports. Managed all orders, insurance billing, obtaining authorizations, verifying patient insurance eligibility and product shipping. Resolved denials and appeals to Medicare including ALJ hearings.
2005 – 2007
ARC Billing Services
Clearwater, FL
Duties: Created in house department for outside physician to handle all sales of his 40 person sales staff. All sales were faxed to my office where I approved each patient’s insurance coverage, ordered product, dropped shipped product to patient. Prepared invoices for billing to Medicare and reported payroll. Originally hired as a biller then given this department to develop with no previous experience. All self-taught and very successful.
2003 – 2005
North American Health Plans
Claims Analyst
Duties: Lived in Niagara Falls, Ontario and telecommuted. Processed claims for multiple groups. Complete knowledge and ability to handle multiple plans. Later promoted to Senior Analyst for designated groups. Primary contact for client relations. Processed claims, overpayments and adjustments. Customer service calls.
2003
Medical Staffing Network
Various Temp Positions
Collections & Billing
2000 – 2001
Joliet Oncology
Business Office Manager
In a 6-physician office-maintained physician credentials for HMO & PPO contracts.
Closed daily and monthly business. Ran all reports to maintain a close eye on A/R. Ran monthly patient statements. Ran all electronic billing, posted electronic Medicare payments. Used Medic billing system and was the Medic system manager for entire office. Held weekly billing meetings to maintain awareness of staff and their responsibilities and to resolve any issues they may have.
1997 – 2000
Concentra Preferred Systems
Fee Negotiation Specialist
Duties: Contacted physician offices, hospitals and DME companies to negotiate discounts in return for prompt pay of the claim.
1995 – 1997
OakBrook Surgical Center
Billing Coordinator
Duties: Performed all billing for OBGYN practice and surgical facility. Kept all billing up to date. Charges were billed out within 3 days of service date. Billed off chart notes and operative reports.
1993 – 1995
OBA Midwest
Benefit Specialist
Claims Examiner
Third party administrator, processed claims for health & welfare funds. Processed medical, long- and short-term disability claims. Customer service calls
1989 – 1993
Third Party Administrators
Claims Examiner
1986 – 1989
The Travelers Insurance Company
Claims Examiners
Professional references provided upon request.
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