| | | 20,000+ Fresh Resumes Monthly | |
|
|
| | Related Resumes Customer Service Administrative Support San Antonio, TX Project Management, Customer service, AV Support, Help Desk Supp San Antonio, TX Customer Service Technical Support San Antonio, TX Customer Service Technical Support Austin, TX Support Specialist Customer Service San Antonio, TX Customer Service Support Stockdale, TX Customer Support Service Associate Kyle, TX |
|
Click here or scroll down to respond to this candidateCandidate's Name
San Antonio, TX Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLEBold ProfileWORK HISTORY CLAIMS SUPPORT SPECIALISTHealthsmart Benefit Solutions San Antonio, Tx08/2016 to CURRENTWorked productively in fast-moving work environment to process large volumes of claims.Analyzed and addressed escalated claims to resolve issues quickly. Collaborated with internal departments and external vendors to achieve fast resolution of claims.Followed up with customer service department on unresolved issues. Researched and analyzed complex claims to determine next steps and possible outcomes.Maintained accurate and up-to-date records of claim information for future reference.Examined reports, accounts, and evidence to determine integrity and accuracy of information.Prepared and presented detailed reports to management on claims issues to aid in decision making.Developed and implemented strategies to improve claim processes. Generated, posted and attached information to claim files. Provide monthly audit results to manager in regards to completed examiner processed claims and incoming customer service transmittal calls.CLAIMS EXAMINERHealthsmart Benefit Solutions San Antonio, Tx08/1999 to CURRENTPaid or denied medical claims based upon established claims processing criteria.Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations. Verified patient insurance coverage and benefits for medical and dental claims.Managed large volume of medical claims and dental claims on daily basis. Monitored and updated claims status in claims processing system. Reviewed provider coding information to report services and verify correctness.Evaluated medical claims for accuracy and completeness and researched missing data.Identified and resolved discrepancies between patient information and claims data.GMResponded to correspondence from insurance companies. Followed up on denied claims to verify timely patient payment and resolution.Researched and resolved complex medical claims and dental claim issues to support timely processing.PROFESSIONALSUMMARYQualified Claims Examiner and Claims Support Specialist versed in investigating claims, verifying information and highly experienced in claims processing and claim auditing. Friendly and upbeat team player with organized and disciplined approach. Offering 24 years of insurance experience. ACCOMPLISHMENTS I have built a good rapport with our external PPO networks. I work closely and professionally with them when consulting on issues, rush repricing or delay in returns. I work together with them on ways to improve the delay repricing and how we could help one another. This process has helped their turn around time from 30 days to 14 days.SKILLS Medical Terms and ProcedureKnowledgePolicy Requirements andEligibilityLearning StrategiesICD CodesHCPCS CodesCPT CodesUB92 BillsHCFA BillsDental BillsMedical TerminologyBenefits GuidelinesInsurance Coverage LimitsCritical ThinkingKnowledge of HIPAA RegulationsCustomer ServiceHealth Insurance IndustryKnowledgePolicy and ProcedureExplanationsMicrosoft OfficeReport and Records ReviewCustomer InquiriesTime ManagementProject RequirementsGreat Mathematical SkillsCreative SolutionsProduction GoalsSpecial ProjectsClaims AdjustmentsActive ListeningTeam MeetingsInformation UpdatesSpecial HandlingComplex Problem-SolvingRim SystemQuicklink SystemDocument Uploading10-Key TouchEDUCATION BACHELOR OF BUSINESS MANAGEMENT EXPECTED IN 12/2024 BACHELOR OF BUSINESS MANAGEMENTUNIVERSITY OF PHOENIX, Phoenix, AZHigh School DiplomaMccollum High School, San Antonio, TX05/1991CERTIFICATIONS Dean Vaughn medical terminology 1,2,3, Anthem - 1996 |
