Medical Claims Specialist
Resume:
Bolingbrook Il,*****
************@*****.***
Sarah J. Bradley
Objective To utilize proven abilities in Healthcare & Patient services with a dynamic growth- oriented enterprise where contributions to organizational objectives would result in long-term association and opportunities for further advancement. Summary of
Experience
Primary & Secondary Insurance Billing Collections & Reimbursement Workman’s Comp Claim Adjuster Claims Examiner
Medical Claims Specialist / Collections /Revenue Cycle Specialist Patient Account Rep,Medical Claims Specialist, Medical Claims Examiner Experience
03/22 –11/24 SEIU Health& Welfare Fund (Remote ) Chicago, IL Medical Claim Examiner: Duties includes reviewing and processing health insurance claims submitted by healthcare providers, verifying the accuracy and completeness of claim forms, checking patient eligibility and coverage, and applying insurance plan rules to determine whether to approve or deny payment based on medical necessity and policy guidelines; essentially acting as a gatekeeper to ensure the insurance company pays only for legitimate medical services.
2/21- 2/22 Innovista Health Solutions (Remote) 814 Oak Brook, IL Workman’s Compensation Claim examiner Adjuster: Duties Includes: thoroughly investigating and evaluating workers' compensation claims submitted by injured employees, determining eligibility for benefits, assessing the extent of injuries, and authorizing appropriate payments for medical treatment, lost wages, and other compensations, while ensuring compliance with relevant laws and company policies; essentially investigating and managing claims to reach a fair settlement for both the injured worker and the employer.
12/18 –8/20 Aetna/CVS 1333 Burr Ridge Pkwy Burr Ridge IL Patient Account Representative Duties includes managing patient billing and accounts by verifying insurance information, posting charges, collecting payments, resolving billing discrepancies, communicating with patients and insurance companies regarding outstanding balances, and ensuring accurate patient records are maintained within healthcare facilities; essentially acting as a liaison between the patient and the billing department to facilitate smooth financial transactions. 04/13-12/18 Amita Health 1000 Remington Rd Bolingbrook Il, Revenue Cycle Specialist: Duties includes: thorougly managing the entire patient billing process, including patient registration, coding medical services, submitting insurance claims, following up on outstanding payments, and resolving billing discrepancies, ensuring timely and accurate revenue collection for a healthcare facility of a hospital or clinic.
6/10-3/13 Assurecare Risk Management Bolingbrook IL Medical Claims Specialist Duties includes: Review claims for accuracy of submission Adjudicate claims ensuring that eligibility (including COB), referral/authorizations, payments are appropriate based on contracts, regulations, industry claim payment standards and MCO policies and procedures. Evaluate the appropriateness of denials and create proper denial notifications and documentation. Research and resolve any disputed claim payments returned from providers. Education Malcolm X College- Chicago IL- Certificate Medical Billing and Coding Triton College - River Grove IL- Associate Degree Business Administration
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