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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLE PHONE NUMBER AVAILABLE Seattle, WASUMMARYSeasoned Medical Claims Analyst with 21 years of experience in claims auditing, training, and quality control. Expert in medical billing, claims adjudication, and Medicare regulations; adept at conducting detailed audits and developing training materials. Seeking to leverage extensive background in claims analysis and process improvement in a Medical Claims Analyst role.WORK EXPERIENCEPacific Medical Centers Seattle, WAPatient Account Representative Mar 2023 - Present Develop and implement standards, policies, and procedures for billing and follow-up processes. Manage billing workflows in EPIC, ensuring timely claim submissions and effective follow-ups. Address inquiries and requests promptly to facilitate satisfactory resolution and claim payment through additional documentation when required.Northwest Administrative Services Seattle, WAMedical Claims Auditor & Trainer 2015 - 2023 Conducted comprehensive internal audits to ensure accuracy and compliance in Health and Welfare claims processing. Developed and facilitated targeted training programs for new and existing claims processors, enhancing proficiency and knowledge of system updates and procedural changes. Crafted and distributed detailed claims processing guidelines to standardize and improve operational efficiency. Managed coordination between vendors and Preferred Provider Organizations (PPOs), ensuring seamless integration of benefits and services.The Polyclinic PCN Seattle, WAClaims Auditor/Appeals Coordinator 2014 - 2015 Conducted comprehensive quality control audits on internal processes and high-value hospital claims, ensuring adherence to regulatory guidelines and accuracy in claims processing. Managed timely responses to health plan reconsiderations and appeals, facilitating effective communication with external stakeholders in compliance with established regulations. Developed, implemented, and maintained audit procedures and guidelines, and meticulously reviewed medical records to verify accuracy, leading to the identification and submission of refund requests for erroneously paid claims.AEROTEK Seattle, WAMedicare Claims Investigator 2013 - 2014 Conducted thorough investigations of Medicare claims processing, compiling detailed reports on findings to support management decision-making. Ensured compliance with Medicare Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs), scrutinizing provider charges and verifying the accuracy of claims data including diagnoses and patient financial obligations. Collaborated with Business Intelligence Analyst to develop reports for monitoring claims payment trends and contributed to the preparation of quarterly health plan reports, adhering to technical specifications and regulatory requirements.Noridian Administrative Services Kent, WAFinancial Analyst 1999 - 2008 Analyzed and resolved Medicare Part B claims through comprehensive audits and edits, adhering to established procedures and guidelines. Developed and updated manual processing instructions, enhancing operational efficiency and providing training to staff to ensure adherence to quality standards. Conducted thorough research on system issues and procedural inconsistencies, fostering collaboration with colleagues for effective problem resolution, and maintained accurate claim processing through meticulous review of medical documentation.EDUCATIONAmerican Academy of Professional CodersPhysician Based Medical Coding-CC2015American Academy of Professional CodersCPC-Certification2014Highline Community CollegeMedical Insurance Coding Specialist-CC2015 |
