Claims Processor and Customer Service
Resume:
MICHELE
KORTENKA
MP
***********@*****.**
m
Dubuque, IA 52001
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. PROFESSIONAL SUMMARY
ASTON CARTER / ELEVANCEHEALTH - Claims Processor
Remote / Contract • 12/2022 - Current
Cognizant / CVS - Customer Service Representative
WORK HISTORY
Evaluated accuracy and quality of data entered into agency management system.
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• Followed up with customers on unresolved issues. Collaborated with claims department and industry
anti-fraud organizations to resolve claims.
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Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
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Analyzed information gathered by investigations to report findings and recommendations.
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Checked documentation for accuracy and validity on updated systems.
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Verified client information by analyzing existing evidence on file.
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Generated, posted and attached information to claim files.
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Maintained strong knowledge of basic medical
terminology to better understand services and
procedures.
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Collaborated with claims department and industry
anti-fraud organizations to resolve claims
•
SKILLS
• KEY QUALIFICATIONS
Payment Posting â-ª
Scheduling â-ª HIPAA
Compliance â-ª Medical
Terminology
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• Office Operations
Accounts Payable and
Accounts Receivable
•
• Microsoft Office
• Claims
Ultimate Medical Academy
Tampa, FL • 02/2020
No Degree: Medical Billing
and Coding
Hawkeye Community College
Waterloo, IA • 08/1990
No Degree: Dental Assissting
Jesup Community School
Jesup, IA • 05/1985
EDUCATION
High School Diploma Remote / Contract • 08/2022 - 12/2022 Accenture - Data Analyst/Claims/Analyst, -Intake
Coordinator
Remote / Contract • 08/2021 - 02/2022
Change Heath Care - Claims Representative
Remote / Contract • 10/2020 - 01/2021
Insurance Verification â-ª Insurance Claim Processing â-ª EOBs â-ª Co-Payments â-ª Deductibles
•
Managed Care (HMO â-ª PPO â-ª POS) â-ª Government
Payers â-ª Third Party Payers
•
Greenway Prime Suite EHR â-ª Electronic Medical Records
(EMR) â-ª Electronic Health Records (EHR)
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Medical Billing â-ª Medical Coding â-ª ICD-9 â-ª ICD-10 â-ª HCPCS â-ª CPT
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Medicare â-ª Medicaid â-ª Tricare â-ª CMS 1500 â-ª CMS 1450 (UB-04) â-ª Fee Schedules â-ª Medical Office
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• Procedures, Inbound calls for Open Enrollment
Back Office/Data Entry -Handle inbound calls to resolve customer enquire
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Supported office staff and operational requirements with administrative tasks.
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Applied specific subject matter knowledge to achieve project objectives and to contribute to impactful
outcomes.
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Viewed reports regularly to make sure processing was conducted efficiently.
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Maintained strict confidentiality with all personal data as per company guidelines.
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Handle all claims to approve/disapprove applications,
-Worked with Medicare & Medicaid claims
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Examined reports, accounts and evidence to determine integrity and accuracy of information.
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Worked productively in fast-moving work environment to process large volumes of claims.
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Evaluated accuracy and quality of data entered into agency management system.
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Checked level and type of coverage and evaluated
contracts.
•
Checked documentation for accuracy and validity on updated systems.
•
Sedgwick - Disability Representative Project Coordinator 01/2003 - 01/2021
Concentrix - Data Analyst/Claims Analyst
Remote • 02/2020 - 10/2020
Hills and Dales Child Development Center Group Home - Personal Care Technician/ Data Entry specialist
08/2010 - 06/2013
Generated, posted and attached information to claim files.
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Maintained confidentiality of patient finances, records and health statuses.
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Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
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• Modified, updated and processed existing policies. Data entry -Put detailed packets together for Fortune 500 companies regarding Long & Short Term
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• Disability
• Intake Coordinator
Pulled claims data from CMS systems, completed PI
redactions and imported data for further analysis.
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Assisted CMS with analysis in support of federal health program implementations.
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Led and contributed to planning and design of
claims-based analytical research and studies.
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Applied specific subject matter knowledge to achieve project objectives and to contribute to impactful
outcomes.
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Maintained strict confidentiality with all personal data as per company guidelines.
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Interacted with clients and employees, which helped cultivate positive working relationships.
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Followed up with insured individuals regarding premium and deductibles payments.
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Provided companionship and personal care for special needs patients í Prepared meals, dispensed medication and transported to doctor appointments í Took vital signs, monitored intake and output and encouraged
self-care by demonstrating use of walking aids í Taught appropriate ways to re-position patients, handled light cleaning duties and maintained accurate records í
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s Martelle’ - Cashier / Customer Service
01/2008 - 01/2010
Dr. Hall, DDS - Certified Dental Assistant/ Data Entry Specialist
06/1999 - 07/2000
Hartsook, DDS - Certified Dental Assistant/ Data Entry Specialist
07/1991 - 02/1998
Entered file information into system on day-to-day basis Processed transactions, accepted payments, and
provided prompt, courteous customer service í
Prepared food, stocked shelves and balanced tills í Worked as part of a team and interacted with diverse customers and staff members í Followed all policies as they related to customer confidentiality
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Greeted patients, managed appointments, and kept
treatment records í Proficient in reception, insurance, record-keeping, and general office procedures í
Assisted dentists with selecting instruments, mixing dental filling materials and cleaning work area í Organized and set-up instruments and materials for dental procedures í Maintained knowledge of dental procedures and terminology and provided outstanding customer service í Set up X-rays and other dental tests, ordered dental supplies and maintained stock í Entered medical records into systems, adding patient information, adding other related information through data entry.
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Handled reception, billing, record keeping and general office duties í Answered inbound calls, scheduled appointments, greeted patients and ordered supplies í Assisted dentists in the direct provision of primary care dental services í Prepared patient for treatment, set up and sterilized equipment and took dental X-Rays í Entered medical records into systems, adding patient information, adding other related information through data entry
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AFFILIATIONS
Hands-on, task focused professional who offers strong clinical and customer service skills gained through 12+ years of experience within high-volume dental practices. Follows policies, procedures and guidelines to ensure consistent quality and maintains and safeguards patient privacy and confidentiality. í Attentive to Detail: Review and correct errors, and maintains compliant documentation í Front Office: Verify insurance coverage, Medicare & Medicaid coverage, schedule appointments, and collect co-payments and deductibles í Accuracy: Ensure correct and thorough demographic information for medical records database í Administrative Skills: Microsoft Office Applications (Word, Excel, and PowerPoint) - Type 50 WPM Electronic Medical Records (EMR / EHR) Greenway Prime Suite EHR
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