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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLEPHONE NUMBER AVAILABLESummaryDetail-Orientated Medical Claims processor with experience in professional and institutional claims as well as provider maintenance seeking a challenging and rewarding career in the healthcare industry.ExperienceHealth Smart Claims Processor March 2023-September 2023Processed medical, dental and vision claimsReviewed medical records for authorizationsProcessed professional and facility claimsCorrected and updated provider filesCignaRemote Senior Claims Processor June 2022-October 2022Reviewed and adjudicated medical claimsConducted research regarding coordination of benefitsReviewed provider contractsManually priced claimsReviewed and processed insurance to verify medical necessities and coverage under policy guidelinesWebTpa Senior Claims Examiner October 2019-October 2021Irving, TXResponsible for day to day processing of medical, dental and vision claimsApplied appropriate procedures and policies in accordance with CMS/Medicare guidelinesIdentified and resolved claim edits and denialsResearched plan benefits and verify correct plan loadingResponded to and resolved to provider and member appealsManually priced high dollar claims with accuracySmall Business AdministrationIrving, TX Program Support Assistant November 2017- January 2019Provided administrative and clerical support to legal departmentAnswered incoming Bilingual calls and made outbound calls to assist clients with loan processUpdated client information in various systemsPrepared letters and documents and scanned incoming mailCicerone Health SolutionsBedford,TX Medical Claims Adjudicator March 2014-March2017Researched claims, initiated corrections, and updated historyResearched and processed refundsApplied contract pricing and determined accurate paymentMet and exceeded productivity and quality goalsAddressed and resolved Provider and Member Appeals in a timely mannerLoaded and updated provider filesSkillsProficiency with Microsoft Windows, Excel, Word, SharePoint, TeamsUnderstanding of medical terminology with in-depth knowledge of CPT and ICD-09 coding useful in reading medical reports and determining coverageKnowledge of UB-04 and CMS billingKnowledge of Medicaid and MedicareKnowledge of Coordination of Benefits |
