Insurance Claims Specialist with BCBS Experience
Resume:
Pattie Waters
**** ******* ** *********** ** ****3
Summary
• Prepare claims to be billed to Blue Cross Insurance from Illinois Hospitals
• Check eligibility and benefits verification for treatments, hospitalizations, and procedures
• Check each insurance payment for accuracy and compliance with contract discount
• Answer all patient or insurance telephone inquiries pertaining to assigned account
• Contact other insurance companies verifying other insurance and coverage
• Contact and/or interview claimants, doctors, medical specialists, or employers to get additional information
• Verify how claims were processed requested records or information to get the claims processed for the members
• Process claim questions and work with hospitals, doctors, members and other Blue Cross Blue Shield plans.
• Adjust claims if the information was processed incorrectly, or advised claim was paid correctly per member benefits
• Process Medicare and non-Medicare claims
• Provide timely processing and adjudication of claims
• Examine claims that came from other countries, translated, converted claim from foreign currency to U.S. dollars, and then processed per group guidelines
Experience
Quorum Health
Insurance Billing 2018 to Present
Consociate Insurance
Private Insurance Examiner 2017 to 2018
Blue Cross Blue Shield of Illinois
Correspondent Advocate, Insurance Claims Processor & International Claims Examiner 2006 to 2017 Education
Blue Cross Blue Shield- Claims Processing Certificate of Completion 2006 Warrensburg Latham High School - High School Diploma 1991 Accomplishments & Skills
• Experienced professional who has had the opportunity to cross-train in several areas: office support, clerical, customer service, claims, document retrieval and banking
• Knowledge of insurance guidelines, including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Competent use of computer systems, software, and 10 key calculator
• Effective communication abilities for phone contacts with insurance payers to resolve issues
• Familiarity with CPT and ICD-10 Coding
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
• Knowledge of medical terminology likely to be encountered in medical claims
• Worked as a Customer Service Rep/Document Retrieval Clerk for Corporation Service Company from 1999- 2006
• Worked for the Department of Human Services, from 1998-1999 as an Office Clerk and Receptionist
• Was a receptionists; Office Clerks; Customer Services; Bank Tellers, etc. from 1991-1998
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