Provider Records and Claims Specialist

PROFESSIONAL SUMMARY

SKILLS

WORK HISTORY

Sharon Poole

Murrells Inlet, SC 29576

843-***-**** *********@*****.***

Accomplished Clerical Assistant with Strong Communication and Organization Skills. Efficient at Multitasking. Strengths include Complex

Problem Solving and Customer Service. Four Years Experience with Claims Processing-Processing, Researching and Adjudicating Claims. and Two Years Experience with Provider Research

File and records maintenance.

Provider research

Customer Service

Data Entry

Claims Processing

Sorting Mail

PROVIDER FILE SPECIALIST 01/2018 to Current

PGBA-Blue Cross Blue Shield Of SC - Myrtle Beach, SC Responsible for Establishing and Maintaining Certification and/or Preparation, Review and/or Maintenance of Health Care Provider Files in support of Provider Directories, Accurate/Timely Claims Adjudication and Provider Billing

CLAIMS PROCESSOR 08/2014 to 02/2018

PGBA-Blue Cross Blue Shield Of SC - Myrtle Beach, SC 75 % Researches and Processes Claims according to Business Regulation, Internal Standards and Processing Guidelines. Verifies the Coding of Procedure and Diagnosis Codes. 20% Resolves System Edits, Audits and Claims Errors through Research and use of Approved References and Investigative Sources 5% Coordinates with Internal Departments to work Edits and Deferrals, Updating the Patient Identification, Other Health Insurance, Provider Identification and other Files as Necessary.

CLAIMS PROCESSOR-TRICARE 08/2014 to 06/2015

PGBA-Blue Cross Blue Shield Of SC - Myrtle Beach, SC Researches and Processes Claims According to Business Requlation, Internal Standards and Processing Guidelines. Verifies the Coding of Procedure and Diagnosis Codes.

Resolves System Edits, audits and Claims Errors through Research and use of Approved References and Investigative Sources.

Coordinates with Internal Departments to Work Edits and deferrals, Updating the Patient Identification, Other Health Insurance, Provider Identification and other files as necessary

DATA PREP TECH I 02/2013 to 08/2014

EDUCATION

PGBA-Blue Cross Blue Shield Of SC - Myrtle Beach, SC Sorted and Distribute Departmental Mail. Prepared Packages for Internal and External Mailing. Assisted with Maintaining Departmental Logs, Spreadsheets and Database. Assisted with Processing incoming Trackable Claims, Certified Mail and Correspondence. CASHIER/CUSTOMER SERVICE DESK/MONEY CENTER 04/2005 to 01/2014 Walmart - Surfside, SC

Operated cash register for cash, check and credit card transactions with accuracy. Helped customers complete purchases, locate item

Processed POS transactions, including checks, cash and credit purchases or refunds York Technical College - Rock Hill, SC

Computer Programming

Indian Land High School - Indian Land, SC High School Diploma

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