Medical Claims Processor with HIPAA Expertise

VH

VICTORIA HARRIS

**********@*****.*** 405-***-**** Mobile, AL 36605

Experienced in handling customer queries in live chat environments, providing quick and accurate responses while utilizing effective communication and problem-solving skills.Demonstrates a track record of maintaining high customer satisfaction through attentive and personalized service. Proficient in diverse customer inquiries through chat support,employing problem-solving techniques and effective communication to resolve issues promptly. Possesses knowledge of technical troubleshooting and maintaining high service standards to ensure consistent customer satisfaction.

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• Medical record review

• HIPAA compliance

• awareness

• Claim denial resolution

• Customer service

• ICD-10-cM coding

• Critical Decision-making

• HIPAA

• Insurance verification

• Medical Terminology

• Familiarity

• Insurance claims

• processing

• Claims processing

• proficiency

• Medical terminology

• Provider relations

• Electronic health records(EHR)

• ICD codes

• Active listening

• Claims processing

• Microsoft office

• Computer proficiency

• Data entry

• Documentation skills

• Reporting skills

• Prior authorization

• processing

• Inbound customer service

• Problem resolution

• Complaint handling

• First call resolution

• Payment processing

• CRM software

• Documentation and reporting

• Empathy and patience

Humana Remote Mobile, AL

Medical Claims Processor

05/2023 - Current

Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.Researched and resolved complex medical claims issues to support timely processing.Maintained knowledge of benefits claim processing, claims principles, medicalterminology, and procedures and HIPAA regulations.Verified patient insurance coverage and benefits for medical claims.Reviewed provider coding information to report services and verify correctness.Assessed medical claims for compliance with regulations and corrected discrepancies.Paid or denied medical claims based upon established claims processing criteria.Monitored and updated claims status in claims processing system.Managed large volume of medical claims on daily basis.Collaborated with healthcare providers to ensure accurate billing information wassubmitted, resulting in fewer

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Summary

Skills

Experience

denied or delayed payments.Ensured compliance with all applicable regulations by maintaining strict adherence toHIPAA guidelines and company protocols when handling sensitive patient information Conduent, Remote

Live Chat Agent

03/2020 - 05/2023

Responded to customer inquiries and provided accurate information about products and services via live chat.

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Monitored customer conversations and provided timely, knowledgeable assistance.

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Resolved customer complaints by identifying problems, suggesting solutions and implementing corrective action.

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Developed exemplary writing skills through continued correspondence with upwards ofNumber customers per day.

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• Handled inbound customer chat conversations from various websites.

• Troubleshoot and resolve issues with clear, easy-to-follow guidance. Work with the team to tackle complex problems and escalate when necessary.

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Keep customer satisfaction high with responsive, effective, and friendly support.

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Jump into team meetings and help us continuously improve our support game

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T-Mobile Remote

Customer Care Representative

02/2017 - 03/2020

• Company Overview: Remote

• Answer up to 150 inbound calls

• Notate each account

• De-escalate and show empathy on each call

• Assist with billing inquiries

• Activate cell phones and tablets

• Up-sale at the end of every call

• The ability to navigate multiple systems at once throughout each call.

• Remote

Responded to customer needs through competent customer service and prompt problem-solving.

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• Managed high call volume with exceptional professionalism and efficiency. Helped large volume of customers every day with positive attitude and focus on customer satisfaction.

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Built rapport with customers through active listening and empathetic responses, fostering positive relationships.

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Utilized CRM systems to accurately track customer interactions and update account information.

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• Researched and resolved billing discrepancies to enable accurate billing. Identified, researched, and resolved billing variances to maintain system accuracy and currency.

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• Worked with multiple departments to check proper billing information. Lillie B Williamson High School Mobile, AL

05/2016

Education and Training

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