C H E R I M E D I N A

559-***-****

adu97r@r.postjobfree.com

**** **** ***,

Paso Robles, CA 93230

PROFESSIONAL SUMMARY

Dedicated Medical Claims Processor with in-depth knowledge of insurance claims process. Complete knowledge of processing appropriate claim paperwork, maximizing reimbursement 100%. Tenaciously pursued delinquent patient accounts and insurance claims recovering $500,000 in single year. Team player performed data entry accurately reducing overall record errors.

Focused and diligent insurance professional skilled at protecting company with detailed reviews of previous claims. Collects, interprets and reports on data trends to help insurance group improve future processing and keep loss ratios low. Proficient in detecting fraud and assisting with litigation.

Skilled team player with strong background in stressful environments. Works well independently to handle assignments and always ready to go beyond basics assignments. Quick learner with good computer abilities. Dependable [Type] industry worker equipped for fast-paced work and changing daily needs. Serves customers effectively with attention to detail and hardworking approach. Seeks out opportunities to go beyond basics, improve processes, and increase customer satisfaction.

SKILLS

Audit Medical Terminology

Timely Processing Follow-Up

Verifying Eligibility Critical Thinking

Claims Processing Sound Judgment

Productivity Benchmarks Production Standards

Complex Claims Handling Claims

Ability To Prioritize Ability To Adapt

Leadership Skills Quality Reviews

Insurance Claims Creative Thinking

Problem Solving Organizational Skills

Ability To Work Independently Prepare Reports

Customer Experience Strong Customer Focus

Problem Resolution Ability To Travel

Verbal And Written Communication

CM

Jun 2010

EXPERIENCE

Medical Claims Examiner, Western Growers, Mar 1995 Apr 2021, Fresno, Ca Managed, analyzed and reconciled billing and payment detail. Interacted with customers each and every day via email, telephone and written correspondence.

Maintained assigned claims files in confidential manner. Maintained service standards, statutory compliance, licensing and efficiencies of respective section.

Supported risk assessments and mitigation activities. Maintained confidentiality of information regarding individual performance. Conducted interviews regarding customer service issues. Communicated regularly with team members and management to share information. Documented and communicated all claim activity timely. Managed time effectively, set priorities and met deadlines. Updated client spreadsheets with updated information. Scanned, copied and documented medical records and file information. Performed comprehensive analysis and clinical evaluation of collected data. Maintained clear communication with patients as well as insurance companies. Maintained electronic files with proper documentation. Provided staff training and to coach and mentor successfully. EDUCATION

Bachelor of Arts, Psychology

Brandman University Hanford, CA

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