Claims Administrator
Resume:
HOPE CARTER
***********@*****.*** 470-***-**** Columbus, GA 31904.
Skills
●Medical Billing
●Medical Terminology
●ICD-10
●CPT
●Claim Entry
●Payment Posting
●Insurance Verification
●Customer Service
●Communication
●Time Management
●Problem Solving
●Rapport Building
●Attention to Detail
●Cash handling Expert
●Cultural Awareness
●Numeracy
●Data processing
●Data entry
●Microsoft Office
●Organizational skills
●Data input
●Data transcription
●Collecting information
●Typing manuscripts
●Microsoft Office expertise
●Email communications
●Filing and data archiving
●Advanced clerical knowledge
●Administrative support specialist
●Spreadsheet management
● Point of Sale Knowledge
●Appointment scheduling
●Insurance company knowledgeable Payment processing
●Regulatory compliance
●Appointment confirmation
●People skills
●Critical thinking
●Conflict resolution
●Data evaluation
●Customer relations
●Problem-solving abilities
●Clerical
●Logbook updates
●Excel expertise
●Spreadsheet creation
●Verifying data accuracy
●Error identification
●Data collection
●Technologically savvy
●Inbound and Outbound Calling
●Retail sales customer service
●Call Center Operations
Project management abilities
Experience
Goldfein Alpharetta, Ga Current
Claims Negotiator
●Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
●Delivered quality customer service to assigned, insured and claimants throughout the entire claims lifecycle to promote service times.
●Keys transactions, verifies accuracy, and performs routine math calculations
●Supported efficient handling of complex claims and followed up on open, denied or suspended claims to complete required line items.
●Adheres to established policies and procedures and recognizes deviation from accepted practices
●Reviewed documentation and accounts to gain a full picture.
●Monitored reports to identify claims issues and worked with adjusters to resolve problems.
●Negotiated settlements for uncomplicated claims in accordance with actual company liability.
●Managed asset recoveries for claims, including salvage and subrogation.
●Followed all company procedures to keep data confidential.
●Gather proper documentation and data to prepare claims for submission.
●Assessed processing reports each day to effectively submit claims.
●Investigated claim and settlement deals and reviewed coverage determinations.
●Created master spreadsheet to record procedures, denials and approvals.
ST. Francis Columbus, GA
Medical Billing and Coding Specialist
●Provided administrative support to physicians and interpreted data to assign ICD-9.
●Entered CPT codes and patient information into billing software.
●Reviewed and validated accuracy of charges including dates of service, services provided, location and provider signature.
●Assigned ICD-10 to physicians diagnosis and insured the correct level of service and various other CPT codes.
●Connected with Insurance and patient aging to resubmit insurance claims when necessary.
●Applied HIPAA privacy and security regulations while handling patient information.
●Verified demographics and insurance information to register patients in the computer system.
●Organized and maintained records by updating and obtaining both personal and financial information from patients.
●Obtained necessary signatures for privacy laws and consent for treatment. Assembled registration paperwork and placed identification bands on patients.
●Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations. Processed patient responsibility estimate determined by insurance at pre-registration.
●Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
●Communicated financial obligations to patients and collected fees at time of service.
●Responded to patient concerns and inquiries professionally and efficiently.
●Obtained health, financial and religious information from patients at time of admission.
●Scheduled and implemented patient admissions and discharges. Received patient inquiries or complaints and directed to appropriate medical staff members.
●Addressed patients' complaints-head on, investigated concerns and worked with medical staff to devise solutions.
●Helped patients obtain health care services by setting up referrals. Facilitated communication between patients, medical and administrative staff, administrative staff and regulatory agencies.
●Identified, corrected and reported data entry errors.
●Completed accurate and efficient data entry and database updates to support business operations.
●Input client information into spreadsheets and company databases to provide leaders with quick access to essential client data. Compiled data from source documents prior to data entry.
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Global Payments Columbus, GA Data Entry Clerk
●Input client information into spreadsheets and company databases to provide leaders with quick access to essential client data.
●Identified and corrected data entry errors to prevent duplication across systems.
●Reviewed and updated account information in the company computer system.
●Adhered to strict data confidentiality policies to prevent information leakage.
●Proofread documents and edited materials to correct grammar and spelling mistakes.
●Maintained quality levels above prescribed minimums to support team productivity.
●Verified and logged deadlines in response to daily inquiries and requests.
●Compiled, sorted and verified digital data against source documents.
●Updated departmental standard operating procedures and database to accurately reflect current practices.
●Reviewed source documents to locate required data for entry.
●Compiled and documented statistical information for reports.
●Performed imaging, transcription and verifying tasks to keep office workflows running smoothly.
●Coordinated, scheduled and executed in-depth data entry projects.
●Reduced physical document storage footprint by scanning and eliminating outdated records
Aflac Columbus, GA
Claims Specialist
●Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
●Contacted policyholders, claimants and witnesses to determine liability in auto accidents.
●Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
●Researched coverage and premium options and supplied clients with best coverage available for individual needs.
●Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.
●Investigated and analyzed requirements to improve timeliness of reports to customers.
●Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
●Delivered quality customer service to assigned, insured and claimants throughout the entire claims lifecycle to promote effective service times for all parties.
●Verified details with policyholders and requested additional information.
●Reviewed documentation and accounts to gain a full picture.
●Assessed policy coverage and pulled contracts for review.
●Monitored reports to identify claims issues and worked with adjusters to resolve problems.
New Square Columbus, GA Sales Associate
●Arranged new merchandise with signage and appealing displays to encourage customer sales and move overstock items.
●Sold various products by explaining unique features and educating customers on proper application.
●Built and maintained relationships with peers and upper management to drive team success.
●Answered incoming telephone calls to provide store, products and services information.
●Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
●Assisted teammates with sales-processing tasks to meet daily sales goals.
●Retained product, service and company policy knowledge to serve as a resource for both coworkers and customers.
●Offered product and service consultations and employed upselling techniques.
●Met merchandise processing standards and maintained an organized and accessible work area.
●Coordinated activities with other departments to ensure quality customer service.
●Built trusting relationships with customers by making personal connections.
●Acted as initial contact in addressing customer concerns.
●Negotiated and closed deals with minimal oversight.
VIVI Boutique Columbus, GA Sales Associate
●Built and maintained relationships with peers and upper management to drive team success.
●Answered incoming telephone calls to provide store, products and services information.
●Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
●Assisted teammates with sales-processing tasks to meet daily sales goals.
●Retained product, service and company policy knowledge to serve as a resource for both coworkers and customers.
●Offered product and service consultations and employed upselling techniques.
●Met merchandise processing standards and maintained an organized and accessible work area.
●Arranged new merchandise with signage and appealing displays to encourage customer sales and move overstock items.
●Sold various products by explaining unique features and educating customers on proper application.
●Coordinated activities with other departments to ensure quality customer service.
●Built trusting relationships with customers by making personal connections.
●Acted as initial contact in addressing customer concerns.
●Negotiated and closed deals with minimal oversight.
Education and Training
Chattahoochee County High School Cusseta, GA High School Diploma
05/2017
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