Eagle Mountain, UT

623-***-****

adyrj4@r.postjobfree.com

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