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Click here or scroll down to respond to this candidateCandidate's Name
Dallas, TX Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEWork ExperienceMedical Claims ExaminerAllyhealth Solutions, INC - Dallas, TXMay 2021 to PresentPerforms collection activities, such as monitoring delinquent accounts, payment recouped, resolving billing denials, and answering routine inquiries. Verification of multiple major payers and other miscellaneous Insurance collection accounts to ensure that all payments are accounted for and properly posted. Documents all claims detail received either via phone calls, faxs and paper/ electronic EOB, on a consistent basis. Resolves issues that created a denial within 5 days of receipt of denial. Maintains a thorough understanding of Texas and California Medical Clinic/Hospital Contracts, In/Out of Network Status, NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies. Claims Billing SpecialistUnitedHealth Group - Irving, TXFebruary 2020 to October 2020Review claims for processing research any denials, solve and reprocess any new assigned claims. Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool). Independently complete on a daily basis all documentation and communicate the status of claims as needed adhering to all reporting requirements.LOA Leave of Absent RepSedgwick - Irving, TXMarch 2019 to February 2020To analyze reported Family Medical Leave (FMLA) requests; to make determinations based on state and federal regulations; and to ensure that on-going claim management is within company service standards and industry best practices. Establishes FMLA claims; tracks and codes documentation in accordance with internal workflow processes. Analyzes FMLA claims to determine eligibility and certification in compliance with state and federal regulations. Identifies action plan; determines benefits due; and makes timely case decisions based on service expectations as established by the client. Communicates decisions and on-going expectations with claimants and clientsPublic AdjusterDimont & Associates - Dallas, TXMay 2018 to March 2019Research and verify insurance policy coverage, Present auto repossession claims to insurance companies. Investigate claims by examining photograph, reviewing any recorded statements, and obtaining all other documentation related to the claim(s) and/or prior claims. Negotiate with insurance companies on settlement amount for damages. Dispute denials with tow truck affidavit, purchase agreement and declaration pageCatastrophe Desk AdjusterGlobal Risk Solution Temp, Deployment to FL - Sarasota, FL October 2017 to December 2017 (CONTRACTContact insured after being assigned claims, Interprets and applies policy coverage to loss, communicates policy coverage and benefits to insured. Creates, reviews, and approves estimates for the cost of repairs or replacement of damaged or destroyed property. Properly documents claim files with all activities and submits final report to file for closure. Determines or declines payment and issues check as required. Negotiates with insured, contractors, vendors, public adjusters and attorneys when necessary. Identifies and investigates questionable and possible fraudulent activity. Closure of five to seven claims daily, with a caseload of 50-75 claimsEducationHigh school diplomaTenaha Schools - TexasSkills EMR Systems- 5 years Time management (WC/FMLA/STD)- 2years Microsoft Excel- 15 years Medical Terminology- 15 years Epic (10+ years) EHR systems (1 year) Workers' Compensation Xactimate (4 years) CAT Property Adjuster (2 years) Desk Auto/Property intake (6 years) Payment negotiation- HO/Auto/Medical (5 years)Certifications and LicensesProperty & Casualty Insurance AdjusterOctober 2023 to February 2025Texas- 1954677Status: ActiveEffective date: 10/4/23-02/16/25 |
