Healthcare Claims & Patient Services Specialist

E: ************@*****.*** 813-***-**** A: Tampa, FL 33610

PROFESSIONAL SUMMARY

Healthcare service professional with proven track record in patient communication and problem resolution. Strong focus on teamwork and adaptability, consistently achieving results even in high-pressure environments. Known for collaborative teamwork and adaptability in dynamic environments. Possessing effective communication and program management skills. SKILLS

WORK HISTORY

Windsor Medical Clinic - Insurance Verification Specialist Remote

03/2025 - Current

Concentrix - Medical Claims Specialist

Tampa, FL

01/2018 - 03/2025

Meeting Your Needs - Outreach Specialist

Tampa, FL

03/2017 - 01/2018

Bank of America - Credit Card Fraud Analyst

Tampa, FL

01/2016 - 03/2017

• Claims processing • HIPAA • Medicare expertise • ICD-10 proficiency • Managed care • Healthcare compliance

• Provider relations • Data entry • Customer service • Call center experience • Problem resolution • Microsoft Excel

• Payment processing • Follow-up skills • De-escalation techniques • Prioritization • Dispute resolution

• Conducted comprehensive insurance verifications to confirm patient coverage and benefits.

• Collaborated with healthcare providers to resolve discrepancies in insurance information.

• Maintained accurate and up-to-date records in electronic health record (EHR) systems.

• Assured timely verification of insurance benefits prior to patient procedures or appointments.

• Processed medical claims with accuracy, ensuring compliance with regulatory standards and company policies.

• Reviewed claim submissions for completeness, identifying discrepancies and resolving issues promptly.

• Coordinated with healthcare providers to obtain necessary documentation for claim processing.

• Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.

• Developed outreach programs to enhance community engagement and awareness of services.

• Coordinated events and workshops to facilitate information sharing among target populations.

• Established partnerships with local organizations to expand outreach initiatives and resources.

• Recorded, transcribed and maintained confidential client information into applicant tracking system and database.

• Analyzed transaction patterns to identify fraudulent activities and mitigate risks. S D SARA DAVIS

APAC - Billing Processor

Tampa, FL

11/2015 - 01/2016

EDUCATION

Dillard University

New Orleans, LA

Criminal Justice

• Developed and implemented fraud detection strategies to enhance operational efficiency.

• Conducted thorough reviews of customer accounts to assess risk levels and mitigate fraud exposure. Assisted in the improvement of internal controls and policies by providing expert recommendations based on extensive experience in the field.

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• Processed and reviewed billing statements for accuracy and compliance with company policies.

• Collaborated with cross-functional teams to resolve discrepancies in billing inquiries.

• Monitored accounts receivable aging reports to identify overdue payments. Accepted customer credit card payments over phone, set up billing arrangements and processed recurring payments to keep accounts current.

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