Medical Claims Quality Assurance

*** ****** **** * Cincinnati, OH ***** * 513-***-****

**********@***.****

More than 15 years of dependable and professional Medical Claims Processing work. Experiences with validating insurance information, checking for missing data, analyzing medical documents, and ensuring all required criteria are met before eligible payments go out. Track record of meeting targets. Have significant experiences and knowledge of medical and insurance industries and terminologies, and appropriate and accurate coding claims. Ready to use skills for the Provider Pay Reconsider Analyst 1- PS13641. Auditing for Overpayment

Management Disputes

Claims Adjustment

Funds Recovery

Quality Assurance

Daily, Weekly, Monthly Reports

Proficient in all computer programs and systems relevant to medical claims.

Medical Claims Processing Experience for Over 15 Years. Experienced in As400, Facets and Pro Systems.

Effectively communicated with support and administrative teams.

Managed a wide variety of customer service and

administrative tasks to resolve customer issues quickly and efficiently

Learned, referenced and applied product processing information

Display team work as needed to accomplish daily task. Daily follow-up on claims and correspondence.

Cross trained to process different states.

Work knowledge and experiences with Medicare and

Medicaid.

CBS Personnel

650 Northland Blvd

Cincinnati, Ohio 45240

Clerk Typist I / Data

Entry

January 1995 – October 2000

WellPoint Inc.

Mason, Ohio 45239

Claims Processor III

October 2000 - April 2011

Collection Manager Duties and Responsibilities

Collection Managers oversee business’ financial collection department. Ensure all money owed to the company is billed and received correctly and in a timely fashion. Regularly reporting the collection department’s progress and statistics. This was performed each week or monthly, and often requires knowledge of statistics and data analysis. Presented information to other departments to highlight trends and achievements. Represented company, as Non-Legal spoken person with the legal team in court. Core Skills:

High attention to detail and excellent organizational skills.

Knowledge of collection, credit authorization and billing procedures and practices.

Familiar with Customer Relationship

Claims Processor I II and III

10+ years of experience in medical, vision and dental claims processing

Processed other insurance Explanation of benefits, including Medicare and Medicaid

Provided friendly Customer and Provider Service for major health insurance company

Collaborated with coworkers as a Pre-existing expert to correctly process pre- existing claims for medical review

Experienced in CPT, ICD-9 and HCPC coding

Completed basic training for Medical terminology

Performed filing, faxing, copying, and data entry

Trained co-workers on how to process Pre-Existing conditions Queen City MedMart

Reading, Ohio

Managed Collection

Department

September 2011 – April 2014

Anthem BlueCross and

BlueShield

Mason, Ohio 45239

*Rehired: Claims Rep I

(HLTH/DNTL) *

Promoted to Claims

Rep. II (HLTH/DNTL)

October 2014 - Present

School of Word Processing - Los Angeles, California Diploma – 1980 Forest Park High School – Forest Park, Ohio Graduation June 1975 Scarlet Vocational School – Sharonville, OH Graduation June 1975 Linda Jones *513-***-*****

Claims Representative II (HLTH & DNTL)

6942 Pin Oak Drive * Cincinnati, Ohio 45239

Elizabeth Snellings *513-***-***** Email: **********@*****.*** 108 Hickory Hollow Terrance *Antioch, Tennessee 37013 * Tamencia McNair *513-***-*****

855 Blair Avenue Cincinnati, Ohio 45229

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