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Candidate's Name
Street Address  Pennant Ln.Fairburn, GA Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEObjective:To obtain a position where I can use my skills to grow with the company and to excel to the maximum of my abilities as well as growing and expand my knowledge. Experience:04/2015-04/2023, ProMedica Health Care / Paramount Health Care, Remote claims adjudicator-Processing incoming medical claims that were submitted on CMS 1500 and UB04 forms.-Reviewed and analyze medical claims to determine coverage and eligibility- Investigate and gather information to support claim decisions- Evaluate medical records, bills, and other documentation to ensure accuracy and compliance with coding -standards-Apply knowledge of medical terminology, coding systems (ICD-10, ICD-9), and billing procedures to process claims.-Communicating with healthcare providers, policyholders, and other parties to gather necessary information and resolve claim issues-Making claim determinations based on policy guidelines and industry regulations-Documenting claim decisions and maintain accurate records 04/2010-04/2015 ProMedica Health Care/ The Pharmacy Counter, Claims Billing Specialist-The Pharmacy Counter Billing insurance companies on profession medical claims form CMS 1500s for medical services such as Durable Medical Equipment, drugs, and enteral nutrition.-Received incoming questions from clients, payers, and/or clinicians regarding client accounts; initiates data submission for any additional information needed, and interprets information back to the client, payer and/or clinician.-Verified insurance coverage, co-payment, and coordination of benefits and updates client billing information accordingly.-Reviewed, monitors, updates, and ensures timely submission and follow up for payer authorizations.-Prepared paperwork for self-pay accounts sent to collections and adjusts self-pay balances for accounts were sent to collections.-Maintained current knowledge regarding public payers, third-party and first-party payment procedures and regulations.-Monitored dashboard and runs reports daily to monitor and initiate corrective actions as necessary to ensure accuracy and completeness of billing, service, and charge information for timely submission.-Processes daily mail payments and Explanation of Benefits that accompany payments.-Reviewed charges for accuracy and generates claims for billing to payers and/or clients and follows up timely on claim generation errors.-Entered payments received and balances input to deposit.-Investigate denials from payers and initiates timely follow up. Education:Professional Skills Institute, September 1996  June 1997, Diploma in Medical Insurance, Skills in Medical Terminology, Anatomy, Primary, secondary, and third-party payer insurance. Medical benefits, insurance billing and claims processing along with medical records. Special Skills:Computers/Typing- All windows and Microsoft office programs, Excel, Power Point Presentation, Internet Explorer and Microsoft Binder, ICD-9 and Procedure Coding, Typing - 60+wpm. Knowledge in Medicaid, Medicare, HMO and PPO benefit plans, Workers Compensation and Third-party Administrators (TPA). Epic and Brightree knowledge. References. available upon request.