Medical Claims Data Entry
Resume:
ALICIA GABRIEL
** ******** ****** • Hartford CT *6106
•
*************@*****.***
PROFILE
Strong administrative background * Thorough understand of HIPPA laws and OSHA guidelines *
Administrative experience in environments requiring heavy contact with individuals * Solid organization
and problem-solving skills * Demonstrated ability to work independently, handle simultaneous tasks and
meet deadlines * Self-start and quick study * Proven to be trustworthy and reliable
EMPLOYMENT
1199 SEIU/NBF/Medical Claims Department, New York, New York
Claims Coordinator July 2022 – Present
• Consult and assist supervisors, manager in coordinating, distributing, and finalizing Medicare
Secondary Payer (MSP) cases and Medicaid reimbursement and Reconsideration claims.
• Verify member eligibility, review, organize and confirm essential documentation is appropriate.
• Audit all files once Quality Control Reviewers have reviewed and completed spreadsheets.
• Train, coach and mentor staff on MSP and other claim procedures.
• Communicate (oral and/or written) with the various Government agencies, employers, members,
and partner with internal Fund stakeholders.
• Develop and update spreadsheets, maintain statistical analysis for preparation of data for program
reports and presentation.
• Track and manage timely reposes ensuring Demand Letter deadlines are achieved.
• Research system problems, such as claims that did not process correctly. To ensure all claims are
processed according to Fund Policies and Guidelines.
• Maintain MSP/Medicaid case files, purge and send closed cases as needed to Record Retentions
for storage.
• Perform other duties as assigned by management.
1199 SEIU/NBF/Medical Claims Department, New York, New York
Medical Claims Processor III October 2014 – July 2022
• Analyze medical claims and ensure they include necessary information: medical codes, provider
information, medical terminology.
• Process claims submitted by providers and entered information in system.
• Process and update medical claims with minimal errors.
1199 SEIU/NBF/Eligibility Department, New York, New York
Data Entry Clerk III April 2014 – October 2014
• Enter data eligibility information of source and legal documents accurately and efficiently.
• Request pertinent legal documentation from 1199 SEIU members.
• Update member records via computerized and manual reports.
• Perform special projects and assignments as directed by management.
1199 SEIU/NBF/Medical Claims Department, New York, New York
Medical Claims Processor March 2012 – April 2014
• Analyze medical claims and ensure they include necessary information: medical codes, provider
information, medical terminology.
• Process claims submitted by providers and entered information in system.
• Process and update medical claims with minimal errors.
1199 SEIU/NBF/Dental Department, New York, New York
Dental Claims Processor II November 2011 – December 2011
• Process claims submitted by dentist and entered information in system via QNXT 3.4 program.
• Process orthodontic and coordination of benefits (COB) claims.
• Provide clerical support to dental claims department: filing, copying, faxing.
• Process, update and adjudicate dental claims with minimal errors.
1199 SEIU/NBF/Data Management and Integrity, New York, New York
Data Entry Clerk II August 2011 – November 2011
• Provide accurate data entry information for management department.
• Update various provider reports.
• Contact providers for additional information, trouble shooting and analyzing provider information
system.
• Perform additional duties as assigned by management.
1199 SEIU/NBF/ Eligibility Department, New York, New York
Data Entry Clerk January 2011 – June 2011
• Logging members Cobra payments daily in system.
• Data entry and all office related functions: filing, copying, faxing, retrieving mail.
Personal and Professional References Available Upon Reques
Contact this candidate