Customer Service Data Entry
Resume:
Eagle Mountain, UT
***************@*****.***
Tonya S. Kahler
SKILLS
Extensive processing background, including Medicare, Medicaid claims, Medical, and UB. Solid communication skills and proven problem solving skills. I am flexible, adaptable, dedicated, and willing to go the extra mile and learn new things. Proficient in COB, CPT, HCPCS, Revenue Codes, and ICD-9/10. EXPERIENCE
Tyson Foods — Product Distribution
January 2023 - June 2023, Eagle Mtn, UT
Care1st Health Plan — Claims Analyst II
March 2015 - August 2021, Phoenix, AZ
● Adjudicate claims in accordance based on policy guidelines to ensure accurate reimbursement to the provider, manually applying the appropriate benefits and maximums.
● Handled, with great accuracy, AHCCCS claims for the state of Arizona.
● Chosen to assist the California office on SNF claims and adjustments following the TPA wind-down following the loss of the Meritus business.
● Research and analyze complex claims (including COB, resubmissions, etc.), manually applying deductible, coinsurance and copayments as necessary. Cognizant — Claims Processing Specialist
December 2011 - February 2015, Phoenix, AZ
● Accurately adjudicated Medical and Hospital Medicaid claims for multiple states (South Carolina, Utah, and Washington).
● Handled Professional, DME, RX, Home Health, Physical & Occupational Therapy, Inpatient and Outpatient UB-04 claims.
● Accurately adjudicated claims in accordance with the provider contracts, verifying authorization requirements.
● Coordinated benefits with primary Commercial or Medicare coverage.
● Adjusted claims for underpayments, overpayments, and corrected billings. Insurers Administrative Corporation (IAC) — Claims Processor June 1997 - April 2011, Phoenix, AZ
● Processed Medical, Dental, and UB claims with a high level of accuracy.
● Negotiated discounts on high dollar medical claims.
● Performed claim adjustments as necessary.
● Responsible for 10+ individuals to backup the Supervisor, answering questions as needed.
● Assisted data entry when inventory levels rose.
● Provided outstanding customer service, answering questions on benefits/ adjudication.
EDUCATION
Alhambra High School — HS Diploma
August 1981 - May 1985, Phoenix, AZ
Contact this candidate