Support Specialist Commercial Insurance

Todd E. Ponton

www.linkedin.com/in/toddeponton

Summary of Qualifications

• Over eleven years as an experienced professional Insurance Specialist for a major billing company as well as over three years’ experience with Colorado Eligibility and Enrollment for Medical Assistance Program and over 7 months experience as Community Support Specialist with Adams County.

• Resolved Medicare, Workman’s Comp and commercial insurance claims updated information quickly and accurately to charts and graphs for PowerPoint presentations.

• Followed Through on resolving all claims.

Developed strengths in:

Athena HIPAA Guidelines Workman’s Comp

Commercial Insurance Claims Various Provider Portals NexGen CBMS Imagine Waystar

Colorado Medicaid Eligibility MediTec

CPR+ Medicare Claims

Experience

Credentialing Specialist - March 2024 to May 2024 Jefferson Center Mental Health, Wheat Ridge, CO

• Notified Providers to update state registration of current licenses.

• Resolved Medicaid, Medicare, commercial insurance, and workman’s comp claims. AR Specialist - February 2020 to November 2023 PMDS, Greenwood Village, CO

• Resolved complex UB04 medical clean and corrected claims issues.

• Pulled all relevant electronic health records including explanation of benefits local and off-site databases.

• Followed through on billing submissions and proper claims processing via fax, mail, or through provider portals.

AR Specialist - November 2019 to February 2020 Urology Associates, Englewood, CO

• Researched and resolved all denied claims including following up on their status.

• Answered phones where patients paid their bills via credit card and had questions on accounts.

• Sorted and routed incoming mail and stamped outgoing mail for claims and billings. A/R Specialist - July 2019 – August 2019 iQMS, Aurora, CO

• Assisted in Past due and current A/R.

• Performed all aspects of insurance payer follow-up. Insurance Specialist - June 2015 – July 2019 RMB, Inc./Wakefield, Aurora, CO

• Resolved all medical billing issues as assigned for Benefis and Adventist Hospital as well as Workman’s Comp, Medicare, and Medicaid.

• Contacted insurance and workman's comp companies as well as patients to research and follow through on billing issues.

• Used all Internet research tools such as insurance carrier's web sites for claim statuses.

• Followed all HIPAA guidelines.

Claims Adjustment Temp - February 2015 - April 2015 Centura, Englewood, CO

• Ran SSL for claims needing adjustments.

• Adjusted charges off of patient bills that are past timely filing.

• Checked claims to see if format is complete, printed for processing. Community Support Specialist I – May 2014 – January 2015 Adams County, Commerce City, CO

• Analyzed and processed applications for Medicaid, Food Stamps, TANF, Adult Medical Assistance Programs.

• Input applicant’s data on Colorado Benefits Management System database. Eligibility Specialist-Team Lead – March 2012 – May 2014 Randstad, Denver, CO

• Trained and answered questions for new and experienced eligibility specialists.

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