Quality Assurance Claims Processor

Nora Martin

***** ** *** **.

Kountze, Texas ****5

Phone: 409-***-****

Objective:

I am eager to secure a position where my qualifications are recognized and valued. My goal is to streamline processes for my immediate supervisor, contributing to a more efficient and less stressful work environment.

** Professional Experience **

** United Health Group **

** Moline, Illinois **

** 2010 - June 2023 **

During my tenure at United Health Group, I developed a comprehensive skill set and extensive knowledge in the healthcare sector while contributing to impactful projects and initiatives. This experience has equipped me with the expertise to drive results and effectively support organizational goals.

I began my career as a claims processor, focusing on TennCare medical skill sets. Within just six months, I mastered the XC Process, also known as the Momma/Baby Process, and quickly became a reliable expert in this area. Following that, I expanded my knowledge through additional training in Durable Medical Equipment (DME) skills, Coordination of Benefits (COB), Special Needs Plans (SNP), Hawk-I, Choices, and Duplication (Dup).

I further honed my skills in case management before transitioning to Pharmacy and Long-Term Care. Since 2011, I have successfully worked from home, demonstrating my ability to manage responsibilities effectively and efficiently. My roles included load balancing and quality assurance, ensuring accurate processing, billing, and payment of all claims and cases. Additionally, I served as a team leader, training individuals on how to effectively audit a Cosmos claim.

** Skills **

- Typing

- Computer proficiency

- Excellent knowledge of WordPerfect

- Proficient in Microsoft Word

- Ten-key calculator

- Facets

- Omega

- ICD-9

- ICD-10

- QMAC

- ODM (Online Document Management)

- STARS

- ATS

- ISET

- RXWeb

- PAS (Pre-authorization system)

- GPS

- Webex

- Microsoft Teams

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