Claims Adjuster Data Entry
Resume:
x SHARRONS **** RE...
SHARRON BRYANT
**** *, ***" STREET
COMPTON, CA 90222
**********@*****.***
With over 20 years of healthcare experience. My areas of
expertise range from effectively motivating subordinates to
attain company goals, through utilizing strong
organizational skills to increase production while
maintaining accuracy and data integrity. A hard working,
self-motivated team player.
CLAIMS ADJUSTER/PDR RESOLUTION
SPECIALIST APPEALS PDR I1
Ability to read/interpret contracts, standard reference
materials (PDR, CPT, ICD-10, and HCPCS), and complete
product and Coordination of Benefits (COB) knowledge.
Identifies billing irregularities and incorrect payment, error
trends and
recovery opportunities by performing _ retrospective
analysis. Acts to recover
overpayment and recommends solutions to prevent future
issues. PDR process,
Pre-service and post- service appeals. Verify claims
payment issues.
CLAIMS ADJUSITER ih
HMO/PPO/POS/MEDICARE/MEDI-CAL
Determines level of reimbursement based on established
criteria, provider
contract, plan and employer group provisions. Previous
Medi-Cal claims processing experience, knowledge of
State Department of Health Services regulations, and
previous experience in EDI Claims processing
Processes all claims eligible or ineligible for payment
accurately and conforming
to quality, production standard and specification.
Matches authorization to claims, maintains current desk
procedural and reference
materials.
Reviews appeals and complaints; researches any missing or
required information.
Responds by telephone on in writing to providers,
members, or other company
department to process and resolve the claim issue.
Data entry and 10-key skills by touch and sight. Knowledge
of CPT and ICD9
coding, procedures and guidelines. Medical Terminology.
Medicaid, Medicare and
Managed Care experience
Claims adjudication experience on a computerized claims
payment system.
Efficiency and accuracy of claim payments during
processing and adjudication;
Analytical ability. Interpret all vendor contracts.
Knowledge of DRG and APC pricing.
Ability to work in an environment with fluctuating
workloads. Ability to
solve problems systematically, using sound business
judgment.
Assist management with in-house and on-site training as
offered to employees, contracted partners and providers.
Working with internal departments to resolve issues
preventing claims processing or to enhance processing
effectiveness. May assist in testing, changing, analyzing
and reporting of specific enhancements.
EMPLOYMENT HISTORY
11/12/2013 to Present Claims adjuster
Examiner IT
L.A. Care Health Plan
08/2010 to 07/20 — Claims Specialist
DaVita Healthcare Partners Medical
Group El Segundo, CA.
UCLA DEPARTMENT OF ELECTRICAL
ENGINEERING 1988- 2010
Contact this candidate