Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Summary
To obtain a Position working in the field of Health Insurance Billing Claims Processing, Billing, Claims Follow up, Claims Auditing and Denial Resolution
Experience
09/2008 to 04/2015Blue Cross Blue Shield Billing SpecialistBanner Health | , ,
Duties consisted of working in the Insurance module on claims with high dollar amounts as well as clearing older dates of service, while insuring current claims issues were followed up on or did not fall behind.
Processed claims into the BCBSNC and Medicaid (NC Tracks) data bases that did not submit electronically.
Resubmission of corrected claims for adjudication to the Insurance carriers.
Appealed denied claims
Submitted secondary claims with primary EOB's for payment
Wrote off balances to specific accounts when requested by our Physicians or Management.
Worked all inquiries from insurance carriers both in and out of state
Submitted monthly production progress reports Â
Phone resolutions with patients regarding their accounts
Placed calls to Insurance Companies for resolution on appeals, corrected, and denied claims.
03/2001 to 08/2007Senior Claims AnalystGuardian Pharmacy | , ,
Interpreted State and Federal regulations to establish changes to policies that may impact IT and claims processing
Assisted IT staff on the development of IT systems which included new website program testing, electronic and on-line claim submissions, new authorization screens and procedure coding pricing screens
Wrote internal policiesÂ
Audit provider accounts
Perform quality assurance on the claims processing staff and monitored upper level provider accounts for Management
Provided back up to the Claims department, resolved problem provider calls, and assisted claims department with workload as needed.
09/1995 to 03/2001Internal Claims AuditorSanta Barbara Regional Health Authority | , ,
Audited Provider Accounts for Accuracy.
Completed Finance Adjustment Requests, Reviewed and Implemented Special Handling Requests for Management.
Involved with the development and implementation of the new Access to Infants & Mothers (AIM), Healthy Families and In Home Supportive Services (IHSS) Programs.
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Worked on Medicare/Medi-cal/Medicaid Claim sumissionsÂ
assisted Claims department with upper level provider calls and workload as needed.
01/1993 to 09/1995Adjudication SupervisorSanta Barbara Regional Health Authority | , ,
Supervised staff consisting of eight employees.
Performed all functions related to the Adjudication department including paperwork flow, issue resolution, charting of work flow progress, payroll, staffing issues and work scheduling.
Note: In October 1995, the Adjudication Supervisor position was eliminated and I returned to Internal Claims Auditor and assumed all duties of that position.
02/1985 to 01/1993Adjudication SpecialistSanta Barbara Regional Health Authority | , ,
Scheduled individual one on one training with providers and billing staff for review of billing and payment issues and complaint resolutions.
Other duties included special projects as assigned
 Note: June 1, 1986, the contract for the Fiscal Intermediary ended and the program merged and became part of The Santa Barbara Regional Health Authority which continued the processing and payment of Medi-Cal Claims for the Santa Barbara Provider Community.
Education and Training
Expected in June 1978High School Diploma | San Marcos High School, Santa Barbara, CaliforniaGPA:
University of California at Santa Barbara
Supervisory Skills Training: Effective (12-15-93)
Developing Business Writing Skills (9-30-93/10-22-93)
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