Healthcare Claims & Billing Professional with 20+ Years Experience

Karleen Williams

*** ********* ***. ********, *** York .11216 · 914-***-****

Email ·******************@*****.***

Summary Of Qualifications:

A diversified individual with over 20 years’ experience within the healthcare industry.

Extensive experience and knowledge of HMO and PPO operations.

Extensive Knowledge of ICD-9, HCPC, CPT 4 and DRG’S

Medical Billing Certified

Entry level Knowledge of Microsoft Word and Excel

Proven record of consistently producing results in the HealthCare field.

Experience

Kitchen Aide

(nAME OF SCHOOL) New York, ny 10/2015- 12/2016

Assist cook(s) in preparing food as need.

Arrange tables for meal and snack times, as directed.

Distribute dishes, cutlery and food to GAINS after school participants.

Perform necessary cleaning task such as dusting, mopping, sweeping, etc.

Cleaning eating areas before and after meal and snack times.

Wash dishes and utensils according to sanitary practices.

Remove kitchen garbage to outside receptacles, clean containers.

Care for cleaning equipment used.

Assist cook in keeping inventory of kitchen supplies.

Other related duties may also be assigned as needed

Senior Claims Repricer/Claims Adjuster,

MultiPlan, INC. nEW YORK, nY 1999-2011

Software Utilized

MP3 facility/Provider, Issue Tracking, Enterprise, Networx/RIMS, MS WORD/EXCEL

Analysis and data entry of medical claims, both electronic and paper, processing them according to facility, provider and client contracts.

Daily communication with dedicated clients, facilities and providers to verify claim data.

Provide senior level support regarding claims and any questions related to the processing of claims.

Work closely with all departments to assure proper rates applied and noted in the system.

Cancellation and adjustment of claims as needed.

dATA eNTRY tEAM lEADER,

nylcare Health Plans. Queens, NY 1996-1999

Dedicated to Aetna/US Healthcare

Data entry of patients’ PHI into “GEMS” computerized system.

Basic analysis of medical claims, both electronic and paper, processing them according to facility, provider and client contracts.

Work closely with client to assure proper rates applied and to determine DRG pricing.

Process claims; verify accuracy and distribution of batched claims.

Data entry, termination and maintenance of provider groups in system.

Nurses ‘Aide.

Professional Health Care Agency Bronx, NY 1992-1996

Daily personal care of twenty patients on various floors of a private nursing home

Escort patients to doctors and hospital visits

Completed incident reports as needed.

Marketing Clerical

Sanus Health Plan Jackson Heights, NY 1990-1992

Assistant prepared, maintained and distributed all documentation for marketing and production departments.

Assisted director of personal with various office related duties of a clerical nature.

Assisted with distribution of informative pamphlets and other items at health fairs and information sessions.

Education

Certified Medical Biller

Manahattan Institue. New York, NY

Real Estate Certification

Baruch College, New York, NY

Nurses’s Aide Certificate.

TCI Nursing AME School

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