Transaction Processor Medical Claims

Jo Hall

TRANSACTION PROCESSOR

Lexington, KY 859-***-**** **************@*****.***

Professional Summary

Detail-oriented and experienced Healthcare Transaction Processor with 6.5 years of proven success working remotely for Conduent clients: Gold Coast Health Plan (GCHP) and HealthEquity. Adept at processing complex medical claims, interpreting coding standards (HCPCS, CPT, ICD), and operating in high-volume digital environments. Recognized for her accuracy, efficiency, and commitment to meeting deadlines and quality benchmarks in remote settings. Key Skills

HCFA & UB Medical Claims Processing

HCPCS, CPT, ICD Coding

DRGs & EOB Interpretation

FSA/HSA Receipt Reimbursement

Letters of Medical Necessity (LMNs)

Optum Red Book Drug Pricing

Long-Term Care & OHI Claims

Preauthorizations and Authorizations

Citrix Software Environment

Remote Communication & Productivity

Microsoft Office Suite

Experience

Conduent (Remote) – Healthcare Transaction Processor Gold Coast Health Plan (GCHP) March 2019 – August 2024

Processed high-volume claims using HCFA (clinics) and UB (hospitals, LTC) formats.

Reviewed and resolved Explanation of Benefits (EOBs), applying proper approvals and denials.

Applied HCPCS, CPT, and ICD codes with attention to DRGs and authorization requirements.

Utilized the Optum Red Book tool for prescription pricing on claim submissions.

Processed complex cases including long-term care spreadsheets, non-medical Other Health Insurance (OHI), and maternity ("Mommy & Baby") claims.

Reviewed and processed Letters of Medical Necessity (LMNs).

Operated in a Citrix-based system with consistent quality evaluations. Conduent (Remote) – Transaction Processor

HealthEquity August 2024 – Present

Handled HSA/FSA receipt-based reimbursement claims with strict accuracy.

Conducted data entry for HSA member check deposits and account transactions.

Maintained compliance with privacy and financial accuracy regulations.

Demonstrated adaptability in shifting from medical claims to financial claim processing. Additional Work History (Prior to 2019)

Available upon request. Includes warehouse logistics, shift management, and customer service roles with companies such as Amazon, Innotrac, Wal-Mart, and Arby’s, where Jo developed leadership, communication, and organizational skills.

Education

High School Diploma – Ashworth College, Norcross, GA (2018)

Contact this candidate