Customer Service Claims Processor

ANDREA C. MASSEY

**** ***** ****** **** ****, SC 29732 803-***-**** **.***********@*****.***

Dependable administrator skilled at managing diverse needs in challenging, demanding environments. A friendly and energetic professional with excellent communication and prioritization skills.

EXPERIENCE

JUNE 2021-presently ASSET SPECIALIST DOC SERVICES

Receiving and reviewing labor records and verifying this information by reaching out to employees to get clarification when needed. Ensuring that all the required and correct information is entered into a work order for accurate and timely billing to the customers. Maintaining and Updating the equipment that we service in our customers locations. 2021-2022-Account Receivables/Billing, 2022-8/2024-Payroll Clerk.

NOV 2018-MAR 2021 CLAIMS PROCESSOR MAESTRO HEALTH

Determine covered medical insurance benefits in accordance with the provisions of the plan. Processing and resolving medical claims, documenting actions, maintaining quality customer service, and ensuring legal compliances. Establish proof of loss by studying medical documentation, assembling additional information as required from outside sources including claimants, physician, employer, hospital, and other insurance companies, initiating, or conducting investigation of questionable claims.

MAR 2017 – NOV 2018 MEDICAL BILLER & CODER THERAPY WORKS 4 KIDS LLC

Translated information from patient records, treatments, tests, procedures, and diagnoses into the standardized codes used to bill patients and third-party payers such as insurance companies and Medicare. Contacted payers regarding nonpayment and denials for treatment. Initiated authorization for services and submitted appeals on behalf of the patients for denied services.

JAN 2013 – MAY 2016 MEDICAL & PHARMACY CLAIM PROCESSOR KEY BENEFIT ADMIN

Entered numerical data into database in a timely and accurate manner. Actively maintained current working knowledge of CPT, ICD-9, ICD-10, coding principles, government regulations, protocols, and third-party requirements regarding billing. Precisely evaluated and verified benefits and eligibility. Coordinated benefit payments with other Insurance companies to ensure no overpayments to providers. Prepared training documents for the processing of Prescription Durg claims along with training employees on this product.

AUG 2000 - MAY 2007 SR CLAIMS PROCESSOR/ADJUSTER/CORRESPOND CIGNA

SKILLS

Medical Terminology Resolute Collaborator

CMS-1500 & UB-92 Billing Flexible

ICD-9 & ICD-10 coding Excellent Multi-tasking ability.

Rapid 10-key data entry Strong Computer skills, Microsoft Office

EDUCATION

Winston-Salem State University

REFERENCES Available upon request

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