Customer Service Claims Processor

Lora Harris

Professional Summary

Adept at navigating complex healthcare environments, I leveraged my certified coding expertise and exceptional customer service skills at Sutter Health to enhance claims processing efficiency. My proficiency in electronic health records and commitment to HIPAA compliance have consistently improved patient experience and operational workflows.

Motivated and conscientious individual skilled in scheduling appointments, verifying insurance, and managing patient records in healthcare settings. Experienced in utilizing electronic medical record systems to maintain patient profiles and billing information. Dedicated to improving satisfaction and providing an excellent healthcare experience.

Experience

MOSC Patient Service Representative III

September 2024 to Present

UNIVERSITY CALIFORNIA DAVIS (TES) - Sacramento, California City Letter Carrier

January 2024 to August 2024

UNITED STATES POSTAL SERVICE - North Highlands, California Claims Processor II (Remote)

November 2022 to September 2023

R1 GLOBAL MARKETING LLC - Roseville, California

Claims Processor II, Revenue Cycle-CBO Representative May 2003 to November 2022

SUTTER HEALTH SHARED SERVICES - Roseville, California Non-Government Electronic Claims Processor

MANPOWER TEMPORARY SERVICES - Sacramento, California Address: Sacramento, California 95825

Phone: 916- 216-7592 - Email: **********@***.***

Perform a variety of medical office duties, including, obtaining referrals, obtaining authorizations; insurance verification, scheduling patient appointments/procedures, triaging phone calls, customer service

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• Delivering mail: Delivering mail to businesses and homes along a set route, either on foot or by vehicle

• Collecting mail: Picking up mail from street letter boxes and customers

• Sorting mail: Sorting mail by delivery sequence, including packages

• Maintaining routes: Maintaining routes even in bad weather Assisting customers: Answering questions about postal services, providing change-of-address cards, and selling stamps

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• Collecting postage: Collecting postage due for delivery or other services

• Holding mail: Holding mail for customers who are away from home

• Directed processing and resolving of claims and appeals for Sutter Health

• Appealed claims with payer for the underpayment of medical claims Collaborated with team members on complex and specialized patient and insurance scenarios to find the best solution for resolution

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Supported delivery of all billing services by final- and higher-level auditing, correcting, and submitting HMO, Medicare Managed Care, Medi-Cal Managed Care, POS, PPO, and capitation claims

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Led processing of all claim-related follow-up on payment delays, taking corrective action to finalize account disposition, performing all aspects of hospital and facility billing per contract, and filing appeals to payer

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Demonstrated knowledge of medical terminology, medical coding, various insurance documentation requirements, patient accounting system, and HIPAA regulations

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• Communicated with patients, physicians, associates, leadership, and providers

• Prioritized, resolved, and escalated complex problems

• Audited claims for medical or hospital services prior to billing to ensure all documentation was accurate Medical Claims Examiner

INSURANCE OVERLOAD SYSTEMS - Sacramento, California Medical Instructor / Medical Biller / Medical Administrative MED TEMP PERSONNEL - Citrus Heights, California

Patient Accounting Representative

PERINATAL & PEDIATRIC SPECIALISTS MEDICAL GROUP - Sacramento, California Medical Coder

CASE MEDICAL GROUP - Sacramento, California

Education

Completed coursework towards B.A. : Interdisciplinary Studies, Emphasis in Paralegal Studies NATIONAL UNIVERSITY - Sacramento, CA

Certification : Medical Assistant

Winterstein Adult Center - Sacramento, CA

Certification : Billing and Coding Specialist

Elk Grove Adult And Community - Elk Grove, CA

Skills

Certifications

Oversaw electronically billing UB92s, HCFA1500 claim forms, documenting patient accounts, contacting patients, and insurance companies as necessary to complete billing process

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Led processing of medical claims for professional services for IPA commercial claims, processing tracers, correspondence, working pended claims, and processing vision claims

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Aided medical office procedures for general insurance billing, coding, collections, billing medical claims for HMOs, PPOs, managed care, commercial insurance, and government claims and authorizations

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• Processed medical claims accurately and verified accuracy of follow-up on patient accounts to payers

• Oversaw processing of denials and appeals, and resolved aged accounts

• Managed processing of claims for HMOs, PPOs, managed care, and commercial accounts

• Demonstrated extensive knowledge of computerized billing programs

• Oversaw ICD-9, CPT, HCPCS and ASA coding for medical billing company

• Processed medical claims for group of anesthesiologists

• Followed up on rebills and answered phones

Worked with Medicare, Medi-Cal, private insurance billing, workers' compensation, HMOs, PPOs, and managed care

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• Certified Coding Specialist • ICD-9

• ICD-10 • CPT

• ASA Coding • HCPCS Coding

• Microsoft Word • Microsoft Excel

• Right Fax • Cirius

• NThrive • Epic

• Novus Bill Pro • IPPS

• Customer service • Scheduling appointments

• HIPAA compliance • Medical terminology

• Medical insurance • Appointment scheduling

• Medical billing • Insurance verification

• Verbal and written communication • Multitasking and organization

• Phone and email etiquette • Scheduling diagnostic procedures

• Certificate in Medical Assistant Program • Certificate in Paralegal Studies

• Certified Coding Specialist

Contact this candidate