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Candidate's Name
Battle Creek, MIPHONE NUMBER AVAILABLEEMAIL AVAILABLESUMMARYMeticulous insurance professional with expertise in insurance procedures, medical terminology and hospital billing systems. As well as, 10+ years of experience in investigating and processing auto and injury claims. Knowledge and implementation of procedural medical billing and coding. Excels in critical thinking, conflict resolution, and time management. Seeking an opportunity to utilize my substantial experience and proven skills to effectively fill an insurance claims or billing and coding specialist position.SKILLSInsurance VerificationCodingTeam collaborationConflict mediationInsurance billingExcellent judgmentInvestigative researchBilling dispute resolutionEXPERIENCECARLE BROMENNBloomington, ILPatient Account Representative 01/2021 to 09/2021Collaborated with relevant parties to resolve billing issues, insurance claims and patient payments.Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.STATE FARM INSURANCEBloomington, ILClaims Specialist 07/2018 to 09/2020Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.Contacted policyholders, claimants and witnesses to determine liability in auto accidents.Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.Verified details with policyholders and requested additional information.Determined liability, compensability and benefits due on each claim.Consulted with field support team, claim manager and other entities to receive support specific to assigned claim.Obtained recorded statements from insumeds, claimants, and eye witnesses to assist with claim investigationWorked in a high-call volume environmentSTATE FARMPortage, MIMedical Claims Processor 11/2004 to 07/2018Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.Accurately processed large volume of medical claims every shift.Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.Verified policy holder data, including age, contact number and physical address.Complied with confidentiality regulations in handling customer information.Checked documentation for appropriate coding, catching errors and making revisions.Collaborated with fellow team members to manage large volume of claims.Retained strong medical terminology understanding in effort to better comprehend procedures.Reviewed CMS1500s, UB04s & Explanation of Benefits for proper billingAnalyzed ICD-9, ICD-10, CPT and HCPCS codesEDUCATION AND TRAININGASSOCIATE OF APPLIED SCIENCE: WORD PROCESSING 05/2004Kellogg Community College, Battle Creek, MIASSOCIATE OF APPLIED SCIENCE: MEDICAL SECRETARY 05/2004Kellogg Community College, Battle Creek, MI