Health Data Analyst
Resume:
Dedication Responsibility Excellence Attitude Motivation
Sherrie McMurdy
**** ********* ***, ***** ********, CO 81504 C: 970-***-**** adlube@r.postjobfree.com
Summary
Focused and dedicated health insurance professional motivated to provide superior customer service. Analytical thinker and innovative problem solver, comprehensive knowledge of government and private claims processing and adjustments.
Skills
QNXT systems
I Facets systems
NetworX pricer
Maces
Sharepoint
Proficient in Excel, Word and Power Point
Limited hospice and home health claims and contract experience
Collections
Professional and hospital claims processor
Claims Auditor
Experience with Medicaid, Medicare and Commercial plans
Strong interpersonal and communication skills
Self-directed
Lead and supervisor experience
Trainer
Coding review
DRG pricer
Telecommuting experience
Strong knowledge of explanation of benefits and coordination of benefits
Various health insurance databases
Working knowledge of Access
Professional and hospital contracts
Work Experience
Claims Adjuster/Senior rep for claims and Provider Service April 2012
Jacobson Solutions-Chicago, IL (assigned to YourCare Health Plan)
Processed and adjusted medical and hospital health insurance claims
Trained staff on Medical and Hospital Health insurance claims
Member/provider customer service senior representative
Project lead for an ever-changing staff of 20+ employees
Developed and implemented a process for working with providers to recoup overpayments
Researched reason for claims being denied with providers. Resolved errors and adjusted claims as needed
Claims Adjustment Team Supervisor 2005-April 2011
Rocky Mountain Health Plans, GJ CO
Inventory management
Created and directed processes
Employee management
Developed a check process
Backed up the data analyst
Created a manual for my team
Supervised eight employees
Claims Vertex Supervisor
Rocky Mountain Health Plans, GJ CO
Inventory management
Supervised six employees
Claims Re-Adjudication Team processor and Lead 2004-2005
Rocky Mountain Health Plans, GJ CO
Helped with inventory management
Fielded staff questions
Processed claims
Customer Service 2000-2004
Rocky Mountain Health Plans, GJ CO
Member and provider customer service representative
Quoted benefits
Durable Medical equipment specialist
Education and Training
Bachelor of Arts. History
Colorado Mesa University-Grand Junction, CO. United States
CPC certified
Activities and Honors
Local AAPC Secretary
References
Lisa Siragusa
Director of Claims and Customer Operations
YourCare Health Plans
Rochester, NY
adlube@r.postjobfree.com
Melissa Rivera
Claims Supervisor
YourCare Health Plans
Rochester, NY
adlube@r.postjobfree.com
Theresa Harpole
Trainer/Auditor
YourCare Health Plans
adlube@r.postjobfree.com
Irma Leon
Utilization Reviewer/Grievance
YourCare Health Plans
W: 585-***-****
adlube@r.postjobfree.com
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