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x SHARRONS **** RE...

SHARRON BRYANT

**** *, ***" STREET

COMPTON, CA 90222

310-***-****

advrmj@r.postjobfree.com

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

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