Medical Claims Adminstrative Analyst

JANET L FARMER

***** ********** ***** ********, ** 92563

Home 951-***-**** Cell 323-***-****

********.*****@*****.***

MEDICAL CLAIMS ADMINISTRATIVE ANALYST

Extensive experience in streamlining claims processing. Review, research, analyze and resolve provider/physician medical claim/records based on health plan and contractual agreements. Maintain written and oral communication, interpersonal, policies and office administrative procedures while working with sensitive health and legal material.

SKILLS

Medical Terminology, Human Anatomy, Insurance Programs and Terms, Insurance Verification/Eligibility, Medical Claims Data Entry, Doctor Website Navigation, Microsoft Windows, Microsoft Word, Microsoft Excel, PowerPoint, Internet Proficient, IDX, AS400, knowledge of Medisoft, Diagnoses and Procedures Codes, Access and QuickBooks Pro. Alpha-Numeric/Keyboarding, Office Administrative, Accounts Clerk/ Cashier, and Customer Service.

EMPLOYMENT HISTORY

9/2008-12/2008 NAMM/PRIMECARE Rancho Cucamonga, CA

Medical Claims Examiner

Researched, reviewed and adjudicated CMS 1500 medical claim/records from providers. Processed rescan/rejected claims corrected and updated financial information from spreadsheets. Established office procedures and operations.

9/2006-4/2007 HEALTH NET Woodland Hills, CA

Claims Examiner

Researched, reviewed and adjudicated CMS 1500 and UB 04 medical claim/records based on provider criteria, contracts and group provision plans. Facilitated and accurately processed eligible and ineligible claims for payment in a timely manner. Established office procedures and operations.

10/2002-4/2006 MERIDIAN HEALTH CARE Woodland Hills, CA

Claims Examiner

Researched, analyzed and data entered CMS 1500 and UB 04 medical claim/records from providers/vendors based on provider contractual agreements. Processed member reimbursement, special handling, urgent, priority and special projects in the AS400, V4 and V6 database. Administrative procedures filed, faxed, telephones and processed mail.

9/1999-9/2001 UCLA HEALTHCARE Westwood, CA

Provider Coordinator

Researched, validated and verified providers/vendors information. Reviewed medical claim/records, entered data, W9’s, ICD 9, CPT, Revenue codes and demographics. Set up contract fees in the SMS database. Coordinated agenda and scheduled weekly meetings, filed, faxed, telephones made xerox copies and room reservations.

1/1990-8/1998 ASSOCIATED STUDENTS UCLA Westwood, CA

Accounts Clerk/Cashier

Counted and reconciled service area receipts, currency, check, and bank deposits. Generated financial reports, filed, entered data, encoded checks, trained students and provided customer service via telephones. Balanced books and kept records.

EDUCATION

U S Colleges of Health and Human Services

Medical Biller - Certificate

Medical Coder - Certificate

Certification - Pending

LA College of Micro Technology

Computerized Accounting - College Diploma

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