Service Representative Claims Processor
Resume:
Tabitha Bailey
****************@*****.***
eTeam Solutions
October 11, 2022 to November 11, 2022
Assignment Ended
Process Medical Claims
• Experience in analyzing, reviewing and adjudicating claims for pharmacy, medical, hospital, institutional, and professional
• Experience claims processing and adjusting; task include extensive of knowledge in medical terminology, customer service
• 10+ years of experience in Healthcare, Claim processing, Billing, Medical Records, Customer Service
• 15+ years of experience in Healthcare industry, patient healthcare
• Excellence Customer Skills
Work Experience
Jacobson Healthcare Solutions
Claims Processor
January 2022 to August 2022
• Processing Institutional/Professional claims.
• Processing COB, Medicare/Medicare Claims
• Updated Provider Record to reflect claim image.
• Processed claims using the concepts of co-pays, coinsurance, deductibles, and COB.
• Responsible for sending letters and researching claim issues.
• Responsible for adjusting and denying claims sent from provider
• Reviewed and Researched Appeals upheld and adjusted claims for correct processing of claims.
• Responsible for processing payments, adjustments and denials according to guidelines
• Processed claims worked claim edits/rejections.
Systems: Macess, MHS
Trinity Home Services
Patient Care Assistant\Medical Biller
January 2015 to Present
• Perform regular inspections of Medical documentation and Med Cart.
• Assist with concerns regarding patient care.
• Provide assistance with daily activities and personal care.
• Liaison between patient and nurse.
• Promptly report changes in patient status to nurse staff.
• Manage patient care case load of 5 daily.
• Backup coverage for Medical Biller.
• Responsible for processing payments, adjustments and denials according to guidelines
• Responsible for working EDI claim rejections in a timely manner.
Medical Claims Processor/Customer Service Representative
RXPERTS Pharmacy - Tampa, FL
July 2012 to December 2019
• Maintain daily production of medical claims HCFA 20/HR and UB92 15/HR
• Error ratio was less than 1% on a daily basis.
• Analyze all documents to ensure accurate documentation and citations that comply with laws and regulations.
• Possess extensive knowledge of electronic claims editing and submission capabilities, including online claims processing and query systems. Have expert knowledge of medical billing forms to include the CMS/HCFA 1500 Version 08-05 and Version 02/12 for professional billing of supplies and services; UB-04 for processing of hospitals and institutional bill for services
• Ensure appropriate diagnostic and procedural coding for all Health Care Financing
Administration-1500 (HCFA-1500), Uniform Bill 92 (UB92) and other claim forms.
• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims. Conduct all Internal Desk Audits. Assist Pharmacist when needed.
• Answer customer concerns regarding health plan changes Medicare Part D/ Medicaid
• Managed all returned medications and processed credits
Systems: Framework, DocuTrack, AS400, Facets
Claims Representative
Claims Division Integrity Medical- Contract
January 2010- September 2012
• Process Hospital/Professional claims
• Adjusted claims as needed
• Resolve edits that post on the processing of claims
• Manually Price claims that require Out of network pricing
• Resolve process related queries within defined timelines
• Answer members/providers concerns regarding denied claims
• Respond to SR’s request in a timely manner
Sytems: Diamond, HRP
Education
High School Diploma - Kathleen High School
Certified Hospice CNA/HHA
Skills
Microsoft Office (10+ years), Excel (10+ years)
Technical Skills:
All Microsoft Window products to include; Windows XP/Vista/Windows 8, Microsoft Office 2003/2007,
Word, Excel, Power Point, Access and Health Care Claims Processing System and Facets, Diamond, HRP, Onbase, TPL assist
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