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NEMAIDALUCASNL Lakeland, FL Street Address ,PHONE NUMBER AVAILABLEEMAIL AVAILABLEPROFESSIONAL SUMMARYMeticulous and well-organized claims research and resolution professional with a strong background in the medical field of 20+ years. Makes accurate determinations about claims by diligently analyzing statements, account records and other documentation. Meet processing quality standards consistently. Adapts quickly to new needs and policies. Willing to take on any task to support team and help business succeed. Excellent verbal and written communicator with strong background cultivating positive relationships and exceeding goals. SKILLSClaims Review, Calculations andAdjustment  Claims Processing Software  Medical Terminology Knowledge Data Entry  Attention to Detail and Organization  Teamwork and Collaboration Adaptability and Flexibility  Integrity and Accountability EXPERIENCEClaims Research and Resolution Professional II August 2021 - May 2024 Humana Tampa, Fl Assessed validity of claims and related coverage with careful review of supporting documentation. Clarified payment or denial for each claim based on established rules and processes. Calculated claims amounts following policy data and coverage requirements. Processed claims from returned pended claims reports and documentation containing claim edits. Complied with standard policies practices that allow for some opportunity for interpretation, deviation and independent discretion. Reinforced confidentiality of sensitive information in accordance with privacy regulations and company policies. Provided exceptional service by addressing inquiries promptly and professionally. Managed workload effectively through prioritization strategies to meet deadlines consistently with minimal direction. Operated within defined parameters to identify work expectations and quality standards. Participated in training workshops to enhance knowledge of industry trends and best practices. Patient Services Coordinator and Receptionist May 2012 - August 2021 CORA Physical Therapy Seffner, FL Managed front desk operations during busy clinic hours efficiently. Collected information from patients and processed registration paperwork. Provided assistance to patients by telephone and in-person to resolve various billing and scheduling issues. Attained referrals, authorizations and medical records in order for patients to be evaluated and treated. Verified patients insurance coverage and followed up on missing and incorrect information to help streamline billing. Reconciled co-payment charges, balances and maintained accurate records. Organized patient forms and reviewed charts to prepare for upcoming appointments. Reinforced strict compliance with HIPAA requirements to protect patient data. Initiated additional support and assistance to patients with limitations and translating needs. Receptionist August 2011 - May 2012Broward Orthopedic Specialists Fort Lauderdale, FL Receptionist July 2009 - August 2011Tampa Lung Specialists Tampa, FLReceptionist December 2007 - July 2009Bay Area Urology Riverview, FLReceptionist October 2003 - December 2007Pediatric Care Center Brandon, FLReceptionist November 2002 - October 2003Caban Skin Institute Brandon, FLEDUCATIONHigh SchoolBenito Cerezo Estrada, Aguadilla, Puerto RicoSALARY REQUIREMENTSNegotiableREFERENCESAvailable upon requestLANGUAGEFluentSpanish