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Click here or scroll down to respond to this candidateCandidate's Name
Atmore, AL Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLE Workers Compensation Claims Consultants of MI, MN, SC, NC, WI, and Texas. Entered workers comp claims into Epic. Kept up to date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same. Understood medical terminology and standard medical procedures as they pertain to worker's compensation, U.S. Longshoreman's and Jones Act claims. Evaluated claim exposure, negotiated, and resolved claims. Transcribed audio for 6 adjusters. Experience in handling bodily injury claims.Work ExperienceOperation Associate IIR1 RCM - RemoteJanuary 2024 to Present Call, email, or fax carriers for bill status. View bills in Epic Send itemized bills via mail with medical notes for processing. Update carrier/bill status notes in CDP. View bills, patient information, payment, and medical documentation in Epic. Add workflow information in resolution. Work bills in Que and move to the next workflow. Provide info of claimants to carriers for bill status. Claims AnalystNTT Data Remote Contract - RemoteApril 2023 to January 2024 Paid claims that have a denial code in CenPas using Amisys. Enter codes and follow the workflow chart to properly bring claims to a pay status of 92. Caseload of 100 claims per day Looked up member info in Apollo.Claims Specialist LT (Temporary)MEMIC - RemoteMay 2022 to March 2023 Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed. Administers the delivery of timely, appropriate, and accurate indemnity and medical benefits. Evaluates claim exposure, negotiate, and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution. Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling. Maintains quality claim files. Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate. Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate. Keeps up to date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same. Understands medical terminology and standard medical procedures as they pertain to worker's compensation, U.S. Longshoreman's and Jones Act claims. Claims ConsultantOfficeTeam - Robert Half Staffing Agency - RemoteFebruary 2021 to May 2022Workers Compensation Claims Consultants State of MI and MN Enter New LT/MO claims into Claim Center and Risk masters. Review medical, legal, and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims. Transcribe audio for 6 adjusters. Review claims for processing. Collect all data needed to create/enter the claim. Use Maven to lookup insured information. Email clients, and claimants through ECF. Transcribe all voicemail recordings for 6 supervisors/employees. Enter up to 80 medical notes per day from medical records. Collect required documentation, review file documentation, and make sure all items needed are requested. Ensure that all claim documentation is complete, accurate, and complies with company policy. Establish, maintain, and update files, databases, records, and other documents for recurring internal reports. Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials. Contact and communicate with clients by telephone, e-mail, or in-person. Make follow-up calls and place notes in Risk masters 3rd attempt send for denial. Upload and enter data into Risk Master set diary for second and third attempt to reach claimant, upload documents into OnBase. Update spreadsheets, file data away. Complete Claim input sheet, enter Case management LDW and RTW then close accounts. Lab Assistant/Data EntryCore Diagnostic Laboratories - Birmingham, ALDecember 2019 to February 2021 Entered requisitions into LabDaq, entered billing for UB's and HICF forms. Created new patient accounts, enter. Entered, and verified insurance, scan, uploaded files, created spreadsheets and entered month- end reports onto a shared spreadsheet, received and sorted clinical lab specimens, prepared specimens for testing and analysis, scanned and/or ordered entry of patient and specimen information. Document Control ClerkLexicon, Inc - Birmingham, ALApril 2019 to December 2019 Audit and update EAF, SMS, and VTD drawings. Print blueprints daily. Type all correspondence for project managers. Keep all employees updated on new policies or changes. Assist with light payroll. File and retrieve documents using specific classification and organization systems. Responsible for the orderly recording and keeping of physical and electronic documents, including distributing new documents and discarding obsolete records. Scan documents into Procore, create files, help with orientation, and experience with safety Documents. Workers Compensation Claims Adjuster AL and FLCobbs Allen - Birmingham, ALMarch 2018 to April 2019 Handled month-end report. Transcribed audio. Collect data to set up a new claim in Epic/AS400 Called claimants for initial statements. Entered workers comp claims into Epic. Entered reserves into Epic and AS400, paid bills. Experience in handling bodily injury claims. Transcribe all incoming voicemail/notes from physicians. Entered workers comp billing. Paid bills, printed checks. Mailed out checks. Sorted, stamped, and opened mail. Answered phones. approvals/orders from doctors to health facility Produce digital copies of documents for retention purposes. Excellent Customer Service.Record Imaging ClerkSt. Vincent's Medical - Birmingham, ALMay 2014 to March 2018 ST Vincent's East/R1 Rcm Compiled sorted and verified accuracy of data to be entered in Sovera and One Chart. Billing, scanned all insurance correspondence, fax, copied, answered phones, calculated checks from patients. Entered check information onto a spreadsheet, interacted with Finance department with checks. Performed verification and indexing of imaging for quality batch identification, sorted mail. Excellent Customer Service. Records Management ensured vital historical, fiscal, and legal value are identified and preserved, and that non-essential records are discarded in a timely manner according to established guidelines and identified legislation.ReceptionistNext Total Fitness - Birmingham, ALApril 2012 to April 2014 Next Total Fitness. Made deposits. Welcomed visitors by greeting them, in person or on the telephone; answered or referred inquiries. Directed visitors by maintaining employee and department directories, giving instructions. Entered data for existing and new members. Data entry entered all members information into Pro Sales. Ran cash drawer, open and closed gym, faxed, copied, and sorted mail. Accounts Payable ClerkMarathon Electrical Contractors - Birmingham, ALJune 2008 to September 2012 Identified and resolved any discrepancies to an account. Retrieved, sorted, and distributed mail to Project Managers and other staff. Paid employees by receiving and verifying expense reports and requests for advances. Disbursed petty cash by recording entry; verifying documentation Printed checks for reimbursement of mileage and miscellaneous. Paid vendors and company bills Prepares and processes payments accurately and on time for amounts owed by the company. Reviewed and verified all purchase orders, statements, and invoices needed to prepare payments. EducationCoursework/Bachelor of Science in AccountingStrayer University - Birmingham, ALJuly 2017 to April 2019High school diplomaJefferson State Community College - Birmingham, AL May 1999 to December 2000 |
