Resolution Specialist Claims Processor
Resume:
Tarsha Knowlin
Hampton, VA *****
**********@*****.***
Work Experience
Claim Auditor
AllyAlign Health - Richmond, VA
April 2021 to Present
Analyzing payments, procedures and guidelines of benefits Interpret detailed paid claims reports. Eligibility reports, payment reports and other various reports to determine the eligibility of service.
Adjudicate claims at a rate of department goal
Adjust claims utilizing current billing codes
Correct system error reports prior to final adjudication Process claims based on provider contracts and regulatory legislation. Claims Auditor
BROADPATH HEALTHCARE SOLUTIONS
June 2018 to March 2021
Review audits for processors and coach to audit error Attend weekly meeting for audit, and huddles
Follow up with coaching Request.
Back up processor for Medical, Vision Claims and Facility Claims Research for the claims to include COB, FQHC, Authorization and Medical Review Assist in Return to work Conversation
Assist in inventory
Medicare and Medicaid
Analytical skills
Claims Examiner
NTT DATA Services
October 2017 to December 2017
Process Medicaid claims within 10 days of received date Complete forms for over specific claims including EOB and pulling claims Assist with Backlog of Claims
BROADPATH HEALTHCRE SOLUTIONS REMOTE MEMBER SERVICE 2017 to July 2017
number 2017
Inbound inquiry calls from members and providers
Work with members and staff on process improvements Accepting payments and updating members' account
Change primary care information for members
Provide prescription pricing, premium cost information Provide customers with information for plan benefits and provider networks REMOTE CLAIMS ADJUSTOR
DELL
October 2012 to April 2016
Research health claims
Confirm health claim information
Resolve claims
Perform billing adjustments
Evaluate claims process
CLAIMS RESOLUTION SPECIALIST
AMERIGROUP
May 2006 to August 2012
Process, review, and analyze claims for COB
Investigate the resolution of claims issues
Resolve unpaid medical claims in various health plans Education
BUSINESS
STRAYER UNIVERSITY
2012
Certificate in Medical Administrative Assistance
Tidewater Tech
2005
Certificate in Medical Billing and Coding
Tidewater Tech
2002
High school diploma in General
Hampton, VA
September 1991 to June 1995
Skills
• Medical Coding
• Auditing (2 years)
• Medical Billing
• CPT Coding
• Insurance Verification (1 year)
• ICD-9
• ICD-10
• Medical Terminology (10+ years)
• Medical Office Experience
Additional Information
Skills
Microsoft Office, Microsoft Excel, Customer Service, Microsoft Word, Review Provider Contracts, Review Policies and New Procedures, Claims Adjustor Medicaid and Medicare Line of Business,, Communication, Public Speaking, Auditor, Trainer, Team Building, Claims Investigation Claims Processor, Complex Problem Solving, Leadership, BLE Training, Time Management, Microsoft PowerPoint
PREVIOUS SYSTEMS: MACESS, AMYSIS, FACTES, QNXT, XCELYS, CIXTRIX, OMNI, PORTICO, AMYSIS ADVANCE
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