Provider Claims Information Technology
Resume:
Krista
MacNamara
**** * ** ** *** N Lot **
Muncie, IN 47304
****.***@*******.***
EXPERIENCE
Optum Washington/United Health Group-Remote-Claims Adjuster
August 2020-Present
Adjusted and processed medical claims. Assisted in creating process to adjudicate borrowed network provider claims. Subject Matter Expert on borrowed network provider claims, assisting upper leadership with large volume or escalated issues related to borrowed network provider claims. Created how-to documentation for processes. Managed adjustment projects. Part of Complex Claims team. Performed informal training and coaching. Assisted upper management on data analysis regarding over/underpayment reconciliation. Performed quality audits for new staff in later stages of training. Managed projects, work flow, and assignments in the absence of supervisor and assistant supervisor. Leader of fun activity committee to help foster relationships and team building. Concentrix Insurance Services- Daleville, IN/WAH—
Professional Claims Processor
October 2015- August 2020
Processed Medicare/Medicaid healthcare claims using Step Action Tools, client directives, and various industry specific databases. Participated in on-going training in claim holds, HIPAA and other federal regulations, and various industry security and privacy practices. Assisted with identifying issues preventing claims from being properly adjudicated. Helped test new or updated Step Action Tools to aid in developing clear instructions for other processors. Assisted in training of other processors. Consistently over delivered on production goals. In top 10% of processors for the site for the last three years.
Greenville Technology- Anderson, IN— Production
March 2015- September 2015
Assembled parts for automotive interiors as part of a team. Performed quality inspections of completed pieces. Maintained a clean and orderly workspace.
Madison County Youth Center- Anderson, IN—
Security/Detention Staff
March 2013- March 2015
Supervised campus and residents in a secure juvenile detention facility. Performed administrative duties such as maintaining daily logs and entering intake information. Rebuilt resident tracking database to improve efficiency for staff. Performed rounds to ensure safety and security of female residents. Performed regular rounds to ensure safety and security of campus and buildings. Performed janitorial duties and routine maintenance of first aid supplies, grounds, and staff equipment. Participated in training on local, state, and federal regulations. Received training on de-escalation tactics, first aid, and restraint techniques. SKILLS
Typing: 70 wpm.
Ability to diagnose and
resolve intermediate tech
issues as allowed by company
policy.
Quickly adapt to changes in
technology, policy, or
procedure.
Strong attention to detail.
Proven remote work
capability. I was a good
processor on site, but I
became a great processor
when I started working from
home.
LANGUAGES
Native English speaker. Basic
French and Spanish skills.
EDUCATION
Harrison College, Online— Helpdesk Certification
August 2013- July 2014
Information Technology related coursework with focus on network administration and software. Completed A+ course.
Highland Senior High School, Anderson, IN— General Diploma
August 1997- June 2001
International Thespian Society, Academic Decathlon, various other extracurricular clubs.
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