Summary:

Looking for a challenging and rewarding career in the medical field that I can grow and learn with.

Excellent organizational skills to effectively handle multiple tasks.

Excellent customer service skills with great desire to promote a positive work environment.

Possess great interpersonal communication.

Exceptional knowledge of most medical insurance companies.

The ability to work independently, while using problem-solving skills, on projects/claims that are time sensitive.

Will be willing to work from home or the office.

Experience:

Senior Claims Examiner (Full Time)

November 2005- January 2020

Southern Benefit Administrators, Inc.

5305 Virginia Beach Blvd, Norfolk, VA

Process and adjudicate all medical, dental, and vision claims, that are submitted by mail or electronically.

Run daily reports on claims that are rejected and or pended.

Speak with providers to give claim status and review the providers EOB if needed.

Give member benefits information, what would be payable, co-pays, out-of-pocket amounts, in-network and out-of-network benefits.

Process high dollar claims applying specific criteria.

Process all month end duties that are related to claims.

Very experienced with CPT and ICD-9 coding.

Complete all follow up on claims that information has been recorded.

Attend monthly meetings with supervisors with policy changes/updates.

February 1997- October 2003 Claim Processor (Full Time)

Trigon Blue Cross Blue Shield/ Anthem Healthkeepers

Virginia Beach, VA

Claim Examiner/ credentialing assistance.

Medical and dental claims processing.

151 inquiring responses from providers.

All claims worked from a que.

Worked with medical departments, (knowledge of fee schedule guidelines with manual processing if needed)

Weekly meeting with department supervisors.

Resolution of problem claims and worked within a timely manner.

Contact with provider reps with issues to be resolved.

HIPAA regulations and guidelines.

Monthly audits.

Billing and Front End

March 1993- January 1997

Aaron K. Vaid, MD

Family Practice

Answer phones, schedule appointments.

Verification of patient medical insurance.

Collection of patient copayments.

Input charges to prepare to bill claims.

Collection of all self-pay patients.

Prepared monthly statements.

Write off balances only with the doctor approval.

Review balances for accuracy.

Claims sent manually and electronically depending on the insurance.

Review claims for accuracy of CPT and ICD-9 codes.

Monthly meetings with office manager and doctor.

Daily follow up on all aged claims.

Education:

1986-1988

Norfolk State University

Norfolk, VA

Business Administration Studies

Graduated May 1985

Norview High School

Norfolk, VA

Earned: High School Diploma (Advance)

Trainings, Certifications, and Achievements:

●Medical Coding Certification (Blue Cross Blue Shield)

●COB Training (Trigon Blue Cross Blue Shield)

●Employee of the Quarter

References:

Upon Request

Contact this candidate