Betty Hetherington

Tampa, FL ***** • 813-***-**** • adx9sw@r.postjobfree.com

Professional Summary

Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complexclaims. Committed to maintaining customer satisfaction and contributing to company success.

Skills

Customer-oriented

People-oriented

Positive and friendly

Managing Case Files

Claims Reports and Documentation

Allocating Claims

Advanced Excel Spreadsheet Functions

Quick learner

Excellent work ethic

Claims Understanding

Information Updates

Motivated team player

Skilled problem solver

Customer relations

Referrals/ Auths

Multi-line phone talent

Goal-oriented

Active listening skills

Work Organizing and Prioritizing

Billing Software

Provider Relations

Impatient/Outpatient

Strong client relations

Denials

Prior Authorization Processing

Claims Preparation

Exceptional time management skills

Premium Calculations

Payment Collection

Patient Care and Confidentiality

Filing Appeals

Work History

Claims Case Manager, 01/2020 to Current

Keystone – Remote

Handled claims consistent with client and corporate policies, procedures, best practices and regulations.

Determined proper course of action for claims processing. Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times. Documented and communicated timely claims information while supporting accurate outcomes.

Made contact with insurance carriers to discuss policies and individual patient benefits. Maintained confidentiality of patient finances, records and health statuses. Senior Appeals Coordinator, 09/2015 to 12/2019

Rapid Response Line

Coordinated with contracting department to resolve payer issues Maintained confidentiality of patient finances, records and health statuses. Responsible for denial and appeals claim processing for medical providers, facilities and laboratories, ensuring compliance and contractual obligations and State and Federal laws generating appeals for denied or underpaid claims. Collect, organize and track information received from a variety of resources to facilitate and expedite the processing of appeals

Researched claims and information to deliver solutions and resolve problems. Medical Claims Care Coordinator Associate, 12/2012 to 09/2015 Health Plan Services – Tampa, FL

Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.

Reviewed each step of patient care and made proactive adjustments to avert issues. Paid or denied medical claims based upon established claims processing criteria. Responded to correspondence from insurance companies while Logging, allocating and managing claims.

Determined need for special assessment activities for complex cases, effectively handling care plans.

Worked productively in fast-moving work environment to process large volumes of claims. Education

Associate of Science: Paralegal Studies

Florida Metropolitan University - Tampa, FL

References

Available Upon Request

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