Kimberly Ruff

Philadelphia, PA

adiwyv@r.postjobfree.com

(267) 707- 4271

Dedicated Medical Claims Adjuster with over 10 years' experience maintaining claims processing to contribute company profits. Skilled in the processing of documentation for Coordination of Benefits (COB) and Explanation of Benefits. Recognized consistently for exceeding performance goals and maintaining claims processing to meet production.

#readytowork

Authorized to work in the US for any employer

Work Experience

Customer Service

Multitasker - Philadelphia, PA

September 2019 to January 2020

Medical Case Specialist

Essential Duties and Responsibilities

Answer phones from automated call distribution system Triage daily downloads of referrals corresponding conditions as identified by Veteran's Administration

Verify appropriate CPT and Clinical codes are assigned to each case Communicate directly with claimants and providers

Obtain medical history for specific conditions

Determine appropriate examinations, test and specialist Schedule appointments for examinees including follow-up and rescheduled appointments Ensure all examinees and providers receive necessary documentation Business System Specialist

INDEPENDENCE BLUE CROSS - Philadelphia, PA

March 2019 to March 2019

Scanning Documents

Data Entry

Uploading information into excel spreadsheets

Front Desk Receptionist

GRANT SURGICENTER ENDOSCOPY AND PAIN MANAGEMENT - Philadelphia, PA November 2018 to December 2018

Electronic Medical Records

Patient Scheduling

Scanning Documents

Receiving Copays

Answer Phones

Claims Adjuster

INDEPENDENCE BLUE CROSS - Philadelphia, PA

November 1996 to June 2015

Successfully processed claims for multiple insurance products, including Life, AD&D, Disability, Medical, Lost-of Time, Worker's Compensation

Determined if the policy of the insured covered the loss claimed Investigated claims to ensure they were not fraudulent Reviewed complex claims as an extra set of eyes to assist the claims adjuster and checked on the case regularly to insure proper guidelines were followed Authorized to process employee and high dollar claims for payments Resolved claims through research and analysis within cost, quality and schedule requirements Processed voids, stop payments and refunds to adjust incorrectly processed claims Researched issues and documented solutions for problems Claims Examiner

Provided customer service, including telephone and written inquiries from participants and providers Prepared correspondence regarding claim inquiries, including notification of claimant denials and appeal right

Updated member and provider information in MHS database for claims processing and resolving rejection codes.

Education

Diploma

Germantown High School - Philadelphia, PA

Skills

• Analytical Skills

• Communication Skills

• Time Management

• Confidential Records Management

• Medical Terminology

• Medical Billing Codes

• CPT Coding

• ICD-10

• Medical Records

• Insurance Verification

• EMR Systems

• ICD-9

• Medical Coding

• Medical Office Experience

Contact this candidate