Medical Billing Claims Processor

Debra Hoschar

San Antonio, TX ***** ************@*****.*** 307-***-****

Dedicated and hard-working professional with 25+ years of impressive experience in Federal Employees' medical claims billing and processing. Equipped with a track record of continuous service and professional advancement within a fast-paced environment. Highly knowledgeable on the Federal Health Benefits and System and adept in validating information on medical claims seeking payment from insurance companies. An innovative problem-solver who maximizes productivity and controls cost. A credible leader who can develop long-lasting, trusting, and profitable relationships. Core Competencies

Federal Employees Health Benefits & System Customer Service Insurance Coverage & Metrics Problem Analysis & Resolution Investigation & Evaluation Medical Billing & Payments Strategic Planning & Execution Coordination of Benefits Claims Processing Quality Assurance & Control Meticulous Data Entry Medical Terminology Knowledge Leadership & Collaboration Negotiation & Communication Skills Sound Judgment Strong Initiative Strong Work Ethic Professional Work Experience

Blue Cross Blue Shield of WY, Cheyenne, WY Jan 2019 – Aug 2021 Retired Member Services Federal Employee Research & Correspondence Representative Bestow top-tier support and service by proactively responding to inquiries of Federal Employees, helping members who require assistance, and drafting written correspondence to members and providers.

Utilize critical thinking in troubleshooting Member Services Rep inquiries along with customer and provider complaints.

Develop highly empathetic relationships with members and providers and earned a reputation for exceeding service standard goals.

Resolve inquiries and complaints via written and face-to-face communication in a timely and accurate manner.

Intensively liaise with the Agency/Human Resources to commence with new hires’ Federal Employee Health Benefits.

Offer significant assistance in faxing SF2809 and SF2810 to the Federal Employee Program Operation Center (FEPOC).

Work directly with the FEPOC on issues and updates to the Federal Employees Enrollment information and coordination of benefits.

Maintain accurate, timely, and permanent records of all inquiries into the computer system.

Initiate adjustments for services that were not properly processed by forwarding them to the appropriate area.

Adhere to established service and quality standards and strive to resolve customer concerns in a single interaction.

Recognized for being the most knowledgeable person on the FEPOC/FEHB system among employees.

Knowledge of HIPAA form and the importance of PHI of the members. Blue Cross Blue Shield of WY, Cheyenne, WY May 1990 – Jan 2019 Medical Claims Processor, Multi Levels

Oversaw the management of a large volume of medical claims on a day-to-day basis; accurately utilized claims processing criteria in paying or denying medical claims while complying with strict standards for confidentiality.

Evaluated the accuracy and quality of all data entered into the system to maintain the accessibility and credibility of information.

Collaborated with all staff to ensure the appropriate processing of all claims while securing that set administrative guidelines are utilized extensively as a resource in answering and processing concerns.

Kept abreast with policies for claim processing, principles, medical terminology, and organizational procedures.

Ensured timely completion of projects by reviewing the outstanding request and redirecting assigned workloads.

Processed Dental claims and determined allowable reimbursement limits based on plan specifications.

Competently handled medical claims from physicians for Federal Employees Medical procedures by closely collaborating with the Federal System, where the claims are actually processed and paid.

Prepared claims on the local system to pay medical claims under the Federal Employee Health Benefits (FEHB).

Enforced extensive knowledge and understanding of the benefits for each claim within the system while updating other insurance information in the local system and the FEPOC system, including Medicare information.

Displayed exceptional attention to detail and decision-making skills in approving, pending, or denying claims. Debra Hoschar ************@*****.*** 307-***-**** Page 2 2 Education and Professional Development

Coordination of Benefits and Medicare Information and Updating the Federal System Training Blue Cross Blue Shield of WY, Cheyenne, WY

Technical Skills

Knowledge of Microsoft Office Suite (Word, Excel, Outlook,)

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