Post Job Free

Resume

Sign in

Data Entry Claims Processor

Location:
Richmond Hill, GA
Posted:
March 14, 2023

Contact this candidate

Resume:

Richmond Hill, GA ***** 916-***-**** advwui@r.postjobfree.com

SOMMONNE SADDLER

Successful human resource candidate with 2 years of expertise in employee recruitment, training and payroll management. Adept at building and maintaining positive relationships with employees and management. Strong organizational skills and committed to adhering to relevant laws and regulations. Direct hands-on experience as an executive assistant with calendar management – coordinating and scheduling meetings and or appointments. Excellent with multitasking and prioritizing work as needed with enhanced time management skills. Excellent skills with communicating and writing. Enhanced knowledge with multiple work software. I'm a team player who is flexible, result-oriented who can adapt to a rapid changing environment, workplace, and under pressure of deadlines. PROFESSIONAL

SUMMARY

Proficiency

Outlook365,Microsoft

Products

SKILLS

Knowledgeable in HR

guidelines and

procedures, AR / AP,

Inventory control,

Worker's Comp. billing,

OSHA Laws, ADA Laws and

maintaining client

relations.

● American Sign Language

CPT Codes, ICD 9, and

Modifiers

Licensed national

Instructor in CPR and First

Aid, Knowledgeable in

Heath care data

Processing, CA Medicare

authorizations.

Impeccable medical

emergency knowledge

Software: TruCare, ABS,

OMNI 2.0, Amisys, Pega

Mars, AWD, UNITY, OMS,

Centene.com websites,

ATS and DC Net, TEAMS,

Kronos, Reflexis, Workday,

ADP

HR LEAD 01/2023 to Current

Belk Retail Clothing Store

WORK HISTORY

Define the strategy and manage the HIPAA program for county communication & training; Lead the RFP (Revenue Finance Report) process with a team of 30, through the entire process

Manage the weekly status reports, data tracking, communications, training & internal SharePoint sites

Ensure consistency in the administration of HR guidelines and practices by coaching/advising management on effective ways to handle employee relations, performance management, employee engagement, reward, and recognition programs as well as, disciplinary issues

● Create budget forecasting and reconciliation, GL, benefits reporting

● Verification of wage scales, salary scales, expenses, and allowances Create and verify attendance polices as well as, enter all data and communications as required.

HR SPECIALIST 12/2021 to 01/2023

Kelly, Walgreens Distribution Center

CLINICAL INTAKE SPECIALIST 03/2019 to 05/2021

Veteran's Evaluation Services

CLAIMS PROCESSOR OFFICE ASSISTANT ULTIMATE 12/2011 to 12/2015 Staffing Service

Responsible for HR coordination and administration activities including data entry, maintenance of personnel/medical files, and Occupational Safety Health Administration

(OSHA) log - providing customer service to DC Team Members in areas of payroll, time and attendance, benefits, safety, worker's compensation, leaves, company policies, local DC policies, and training; Handles difficult conversations and communicates information to internal stakeholders; Delivers high level of customer-facing service to Team Members and leaders; Responsible for all onboarding services for new hires

Ensures all Team Members are entered and processed correctly in the Kronos timekeeping system and are processed on a timely and accurate basis

Maintains Human Resources Information Systems (HRIS) with all Team Member personnel transactions

● Applies attendance policy by entering data and communicating as needed Assists the HR Generalist with various events, such as new Team Member orientation, benefits reviews, and Open Enrollment

Responsible for worker's compensation processing for DC employees; including submission of initial claim, data entry into the worker's compensation system and notification to the carrier of the Team Member's medical status and/or return to work

Processes all Family Medical Leave Act (FMLA) and Leave of Absence documents for approval process.

Worked with multiple doctors, to prepare correct equipment and supplies for over 4 providers daily for Psych, Audio, General medical appointments; communicated effectively with primary care physicians or emergency care providers relaying patient needs while managing medical practice administrative needs to provide patient satisfaction and managing front office customer service, appointment management, billing, and administration tasks to streamline workflow

Created and maintained accurate and confidential patient files according to regulatory mandates

● Schedule future appointments, consistently double- checking information and availability Maintained office supplies inventory by checking stock and ordering new supplies as needed

● Recognized by management for providing exceptional customer service. Receive and review medical and hospital claims checking for completeness and compliance with established policies and procedures and for member eligibility

Complete all claims processing functions within the regulated timeframe of 30 days to deny and 45 days to pay and ran batch control report and balance payment totals

● Input claims onto the claims processing system and correct any discrepancies as necessary Work EDE electronic claim queues to correct, modify, and transfer to different queue for additional research

● Identify high balance claims for management review and approval Process coordination of benefit claims for balance after primary insurance payment, deductibles, or co-payments.

Life, Health, And Death Insurance California, Chowchilla, CA License, Insurance, 2019

Graduated – License Field Insurance Agent

Carrington College California - Sacramento, Sacramento, CA Healthcare Administration, 2012

Co Consumnes River College, ASL, Sacramento, CA

American Sign Language, 2010

NCTI (National Career Training Institute), Roseville, CA EMT Program, Emergency Medical Technology, 2000

EDUCATION



Contact this candidate