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Click here or scroll down to respond to this candidateCandidate's Name
Licensed Claims AdjusterDenton, TX Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEAdministrative Skills- 24+ years experience in Physician reimbursement Billing/Collections. Working knowledge of HIPAA, CMS guidelines, CPT/HCPCS codes, electronic claims. Strong organizational, oral and written communication skills. Ability to work in a team fostered environment, multi-tasked environment while being self-motivated. CCC One Auto Estimating, NexGen, Microsoft Excel Computer skills Organizational skills Communication skills Customer service Willing to relocate to: Deployment areasAuthorized to work in the US for any employerWork ExperienceAuto Field AdjusterPILOT CATASTROPHE SERVICE-Fort Worth, TXJune 2024 to Present Deployment Inspect vehicles at customers residence, repair shops for Hail and Wind Damage while using scope sheet and, taking photos Write up Estimate via CCC ONE. Documentation completed in NexGen system. Using hail dent shield to gather needed repairsMember Service RepresentativeSGS Consulting- Christus Health-Irving, TXMarch 2024 to June 2024 Collects and provides patient and payor information to facilitate account resolution. Maintains payor specific knowledge of insurance and self-pay billing and follow up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within Revenue Cycle. Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution. Facilitates member & provider understand of the plan coverage and benefits by thoroughly researching inquiries in an efficient and professional manner Required to assist in training/re-training new and current employees Responsible for handling all incoming calls and the making of outgoing calls as needed in order to resolve any issues or questions Provided excellent understanding of benefits, products, & other health care and/or insurance issues as they pertain to the memberAgent Advocate Inside AdjusterPilot Catastrophe Services-Fort Worth, TXApril 2023 to October 2023Allstate- Insude Auto Adjuster Answering inbound calls; Outbound calls to customers by telephone, written correspondence and/or various electronic media Effectively managing work through task driven queues while multi-tasking in a fast-paced call center environment Supporting our customers through personalized, caring, and simple interactions Investigating, evaluating, negotiating, and settling claims Applying knowledge of policies, and insurance regulations when determining coverage, liability, & damagesAuto Express ECTA- StateFarmTheBest Claims Solutions-Irving, TXNovember 2022 to March 2023 Contacting customers by telephone, written correspondence and/or various electronic media Effectively managing work through task driven queues while multi-tasking in a fast-paced call center environment Supporting our customers through personalized, caring, and simple interactions Investigating, evaluating, negotiating, and settling claims Applying knowledge of policies, and insurance regulations when determining coverage, liability, & damagesTotal Loss Claims Adjuster- AllStatePilot Catastrophe Services-Fort Worth, TXOctober 2022 to October 2022 Hurricane Ian Deployment- 2wk training, Total Loss Flood claims. Class A CDL DriverR&L Carriers-Sanger, TXSeptember 2021 to September 2022 Delivers and unload products using a pallet jack Informed customers of critical details and procedures for submitting claims for damages. Stayed in frequent communication with dispatch to quickly adapt to customer demands and route changes. Maneuvered vehicles with high degree of skill through narrow passageways and around obstructions such as parked cars. Handled load documentation, obtained signatures and provided copies to destination staff. Maintained current Class A CDL with Hazardous Materials and Doubles and Triples and Tanker endorsements.Class a CDL DriverSwift Transportation-Lancaster, TXMarch 2020 to September 2021 Delivered refrigerator items from Texas to Denver, CO, Raton, NM for daily deliveries to a local retail store. Completed on-time deliveries by choosing best and most efficient routes. Operated vehicle safely in highly congested areas with no traffic violations. Adhered to safe lifting techniques to avoid injuries. Medical Claims SpecialistAscension Health-Richardson, TXOctober 2017 to October 2020 Timely follow-up on all accounts assigned, work accounts as established procedures until account is resolved, sent to legal, or disputed Daily calls to payers to obtain payment resolution and account status information Follows and maintains patient, account and client confidentiality at all times Adheres to HIPAA and Compliance Policy Guidelines. Medical Collections SpecialistDynamic Global & Temp Agencies-Dallas, TXJanuary 2014 to October 2017A/R follow up, Timely filing / AppealsCheck mail daily for payments, EOBs, etcPayment posting, Maintained A/R report to keep balances under 120 days. Collected and documented patient medical information such as blood pressure and weight. Performed clerical duties, such as word processing, data entry, answering phones and filing. Medical Collections SpecialistReimbursement Solutions Specialist- Formerly PRS Group-Bellaire, TX September 2008 to December 2013Responsibly managed assigned accounts in an organized and efficient manner, electronic/manual submission of claimsHandle operational issues, including Patient financial service needs Posting Payments, Medical Billing Submission ofAppeals, Train new hire on current software, Assist manager in monthly reports, etc physician fees billed to, Medicare,Managed CareCommercial Driver's License (CDL)Class AState: TXEndorsements: X (Tank + Hazardous) - T (Double/triple trailers) - N (Tank vehicles) Skills Analysis skills MedicareCertifications and LicensesClaims Adjuster(All lines)April 2022 to June 2024 Licensed Home State TX,-2834521 AL,OK, KY, La, FL, GA, NM, MI, MT, WV State Farm Auto/Property CertifiedNotary PublicMarch 2021 to March 2025Notary Id# 13297787-6 |
