Workers Compensation Claims Adjuster:State, Federal and County employe

Marie Antoinette Graves

SUMMARY:

• Seeking a challenging opportunity in the Medical Billing and Coding field which will fully utilize my office experience, technical training, strong work ethic and dedication. Desiring employment where advancement is based on efficiency and contributions to company growth. SKILLS:

• Project Management/Leadership Skills. Insurance fraud expertise with timely litigation resolution.

• Strong work ethic committed to personal accountability, growth and success of any department Implementation or changes.

• Claims file management and processes.

• Skilled in hospital and physician office billing for inpatient and outpatients Medicare, Medicaid, HMO, PPO, Managed care, and commercial accounts.

• Knowledge of CPT-4, ICD-9, HCPC’S and overview of ICD-10 coding and collections

• HIPAA & OSHA Compliant

• Medical terminology

• CPR, BLS and First aid certified

• Excellent communication skills both oral and written

• Taking patient vital signs

• Scheduling patients manually & electronically

• Claims Processor for Worker’s Compensation; State, Federal, and Government

• Proficiency in Microsoft Office Suite, Microsoft Word, Medisoft and Excel PROFESSIONAL EXPERIENCE:

Amazon SAN3 Jan 22 - Jul 22

Warehouse Associate, Chula Vista, CA

• Employed as an Associate at the Fulfillment Center.

• Warehouse duties included stowing, filling orders, and packaging. Also, a member of Safety Committee and DEI Committee.

Robert Montano Law Jan 20 - Jan 22

Paralegal

• Rate values, permanent disability, and future medical care of all worker’s compensation cases. Maintained contact with clients, medical offices, insurance companies and the Workers Compensation Appeals Board.

• Client intake, create, review, and improve law office protocols as well as manage various law office’s calendars. Transamerica Agency Network Apr 19 - Jan 22

Insurance Representative/ Underwriter

• Reviewed insurance applications for compliance and adherence

• Assess clients’ background information and financial status

• Negotiate and define the specific terms of insurance policies

• Collaborate with medical personnel, field representatives, actuaries, and others to obtain policyholders’ personal information for accurately assessing risk factors

• Review insurance claims against policy terms to determine the amounts owed by the insurance company to the claimant.

Villa Rancho Bernardo Jan 17 - Apr 17

Medical Billing and Coding Specialist, San Diego, CA

• Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-9-CM and CPT codes

• Preparing and sending invoices or claims for payment.

• Correcting rejected claims and Tracking payments

• Following up with patients and insurance companies about outstanding bills D&T Billing Sep 15 - Oct 15

Medical Billing and Coding Extern, El Cajon, CA

• Translated patient information and into alphanumeric medical code, collected, posted, and managed patient account payments, submitted claims to insurance companies, prepared and reviewed patient statements, reviewed delinquent accounts and called for collection purposes.

• Processed payments from insurance companies, maintained strict confidentiality, code patient services, data entry, sorted and filed paperwork, followed up to see if a claim was accepted or denied, investigated rejected claim to see why denial was issued, and investigated insurance fraud and report if found. ATI Staffing Solutions Jul 13 - Apr 14

Workers’ Compensation Claims Adjuster, San Diego, CA

• Investigated, reviewed, evaluated, and administered workers ‘compensation claims, reviewed medical reports, filed documentation, reviewed, and approved medical bills for payment, reviewed accident and injury.

• Interviewed and corresponded with claimants, witnesses, attorneys, and physicians, approved claims, or recommended denial, reviewed claims for fraudulent activities.

• Resolves customer complaints by investigating problems; developed solutions; prepared reports and made recommendations to management.

John Mullen & Company Jan 02 - Aug 03

Workers’ Compensation Claims Adjuster, Honolulu, Hawaii

• Developed and maintained relationships with clients and internal relationships to provide effective handling of workers’ compensation claims.

• Maintained workers’ compensation client loss/claims filed and provided updates as needed or agreed upon with Client Executives and clients.

• Notified Client Executives of complex workers’ compensation claims and developed a strategy to work with the adjuster to resolve issues.

• Negotiated with workers’ compensation adjusters on behalf of clients to have positive outcomes related to claims and worked with appropriate internal personnel to review all disputed or denied claims. US Army Veterinary Services Mar 96 - May 98

Secretary (GS-310-05), Puerto Rico, DC

• Performed clerical and administrative duties for 15 Veterinary Services men such as - answering phones, faxing, photocopying, creating files, sorting mail, reviewing, and preparing reports for food inspections. State Compensation Insurance Fund Mar 87 - Jun 94

Workers’ Compensation Insurance Representative, San Diego, CA

• Determined liability, initiated, controlled, and coordinated provision benefits to qualified injured workers for a highly sensitive and complex caseload of workers’ compensation claims.

• Reviewed technical work such as finalization workups, estimated and awarded payment, provided technical and theoretical information to other claims department personnel.

• Assessed trends and issues with the claims department, developed and implemented in house claims training.

• Adjusted (including, but not limited to) liability decisions, setting estimates, all payments to $9,999.00, all compromise & release to $45,000.00, all stipulated awards to 65% permanent disability, vendor assignments and resources commitments.

• Identified and coordinated as requested, needed training, provided guidance to other claim staff when Claims Manager was absent.

AWARDS:

• U. S. Army Outstanding Rating 1996-1998

• State Compensation Insurance Fund Presidential 1993

• State Fund PACE Workers’ Compensation Claims Adjuster 1992-1993

• State Fund Automated Bill Review 1989-1991

EDUCATION:

Western Sierra School of Law Mar 21 - Sep 21

First Year Student, San Diego, CA

Kaplan College October 2015

Medical Billing and Coding Certificate

University of San Diego

Paralegal Certificate

Columbia College June 1998

Bachelor of Arts in Psychology (4.00 GPA)

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