High School Nursing Home
Resume:
Frances Hynes
Westwego, LA *****
**********@*****.***
Objective
Obtain a position with an organization where I can utilize my experience as a claims examiner.
Professional Accomplishment
Claims Examiner, AP Professionals (MVP Healthcare),Rochester,NY June 2011 – April 2012
• Adjudicate/process claims for Government Program products
Claims Examiner, AP Professional (MVP Healthcare),Rochester,NY July 2009 – September 2010
• Adjudicate/process claims for Commercial/ASO Program products
Suspense Operator II, Excellus BC/BS,Rochester,NY November 1986 – April 2009
• Adjudicate/process claims
- Provider(PCP) and Facility
- inpatient and outpatient visits,office visits
- over and under 65 members
- medicare
- skilled nursing facility/nursing home
- other patient liability
- workers compensation,motor vehicle/no fault,other secondary insurance coverage
- verified accuracy on claims/corrected keying errors
• Trained coworkers on processing procedures
Summary of Qualification
• Operating Systems :MS Windows
• Application Systems : MS Office XP, AMYSIS, TOPPS/QWS, CMS Pricer, Service Matrix
Training, Certification, Skills
• Knowledge of CPT,HCPCS,ICD-9 coding systems and medical terminology,basic human
anatomy.
• Basic knowledge of physician,hospital and facility provider reimbursement,as well as, knowledge
of coordination of benefits payment rules/regulations.
• Ability to work independently as well as be an effective team member
• Ability to prioritize multiple assignments with attention to details and deadlines in a high volume
environment.
• Ability to follow procedures
Education
Diploma L.W. Higgins High School, Marrero, LA
• One year of nursing
Contact this candidate