Claims Analyst Specialist

Shrena Lewis

Maricopa, AZ *****

***********@*****.***

***- ***- ****

Performance oriented professional, dedicated to the development and implementation of visible results. Understanding quality and consistently striving to improve client satisfaction. Hardworking team player that enjoys the process of getting to completion of each assigned task.

Work Experience

Claims Analyst Admin

Centene Corp

February 2018 to Present

Experience: Centene Corp.: Claims Analyst Admin. Feb 2018-current

• Process pending medical claims

• Verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility.

• Ensuring payments and/or denials are made in accordance with company practices and procedures.

• Working all skills from Basic, COB and Advanced status of medical-related claims

• Review charges access to the computer system and uses payment or denial codes within established department guidelines and standards

• Verifying health insurance coverage and timeframe eligibility for coordination of benefits processing.

• Ability to learn new concepts and programs quickly, detailed oriented and excellent problem solver

• Meeting department production and quality standards

• Awards/ Recognition: Received Quarterly Centene Corporation

Excellence Award four times

PFS Representative

Banner Behavioral Health Scottsdale - Scottsdale, AZ

August 2015 to September 2018

• Persons Pre-Registration/Registration processes

• Acts as a liaison between the patient and the billing department and the payer to enhance account receivables performance, resolve outstanding issues and patient concerns.

• Posting daily deposits or conducting other work assignments of the patient financial services team.

• Provides financial counseling to patients and their families, explain company financial assistance paperwork when appropriate

• Verify insurance coverage and obtain authorizations and notifications

• Obtain all necessary signatures and documentation required by the patient’s insurance plan

• Was in training for Team Lead

Claims Specialist

Lifewell Behavioral Wellness - Phoenix, AZ

June 2011 to August 2015

• Working Medicare grievance and appeals

• Preparing and submitting claims to various insurance companies ● Preparing, reviewing and sending patient statements

• Correcting and resubmitting claims to third party payers

• Responsible for transmission and reconciliation of electronic RBHA 834 enrollment and demographic files

• Monitoring and resolving daily 834 and demographic reports

• Enrolling initial demographics to Mercy care Website

• Calling the insurance companies and getting authorizations for services

• Working denied claims and resubmitting

Education

AA in Criminal Justice

Everest University College

October 2010

Diploma in s Medical Coding and Billing

Stratford Institute

June 2005

Skills

• Window XP

• Microsoft office suite 200*-****-****

• Nextgen

• AS400

• MSA series

• Cerner

• Emdeon

• ClaimTrak

• Amisys

• CenPas

• Behavioral Health

• ICD-10

• EMR Systems

• Medical Billing

• Insurance Verification

• ICD-9

• Crisis Intervention

• Medical Records

• Medical Coding

• CPT Coding

• Managed Care

• Hospital Experience

• Triage

Languages

• English - Expert

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