Claims Administrative

Wanda

Hinton

*****-****

\wtsha*@gmailcom

Hopkins, SC 29061

SUMMARY

Seasoned medical Insurance Specialtwith excellent planning andproblem solving abies,

Offering 20 plusyearsof experience anda willingness to take onary challenge. Organized,

drvenand adaptable professonalwithsuccesful history managing high czelaadsin

fast paced environments.

SKILLS

© DataEntyy © TeamworkandCollaboration

© Problem-Sohing © customerService

© Coverage Determination ‘© Paymentand investigation Escalations

1 Information Verification (© Chtca Thinking

{© Eligibility Determination ‘© Attention toDetall

‘© VerbalandWrttenCommunication «Active Listening

EXPERIENCE

Claims Processert

columbia SC

MUSC Community Physician / Feb 2000 Curent

* Called insurancecompanies toascertain pertinent information regarding policies and

payment benefit forpatiens

Checked documentation fora propriate coding, catchingerors and making revisions

Handled biling related activities focused on medical specialties.

Assisted claimants, providersand clients with problems or questions regarding claims.

Processed claims forpaymentor forwarded appropriate personnelfarfurther

investigation

Claimadjudicator

Columbia SC

SRC Strategic Resource Compary May 199310 Oct 2001

‘© Based paymentordenialsof medial claims uponwellestablished criteria forcaims

processing

‘© Coordinatedand planned investigations of claims toconfirm compersabilty and

coverage

‘Stayed urrenton HIPAA regulations, benefits claims processing, medical terminology

and ther procedures.

© Corresponsedwithnsuredoragentto obtain information or inform ofaccountstatus

orchanges

1 Reviewed administrative guidelines wheneverquestions arate during processing of

chime.

‘© Sent clinical requestand missnginformation letters to obtain incomplete information

‘Accurately processed large volume of medical claims evey shift,

‘© Processed claims forpaymentor forwardedto appropriate personnelforfurther

investigation

Preparedand revewedinsurance-laim forms andrelated documents.

Used contract notes and processing manual correctly apply group-specific

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