Claims Analyst Resume Example Pridestaff Assogned To Health Plan Of San Joaquin

CLAIMS ANALYST

Professional Summary

Professional Strong administrative skills Receptionist experience Written & verbal communication Leadership abilities Detail oriented Computer literate Contract negotiation Ability to multi-task Customer service Phone etiquette Scheduling Record keeping Time management Highly motivated Medical and Legal terminology Problem resolution Cash handling Teamwork skills Accounts Receivable Clerk who leverages strong organizational, technical and interpersonal skills.

Skills

Superior attention to detail
Ethical approach
Exceptional organization
Analytical reasoning
Familiar with commercial and private insurance carriers
Insurance and collections procedures

Adept multi-tasker
Close attention to detail
Resourceful and reliable worker
Excellent problem solver
Excellent verbal communication

Work History

Claims Analyst06/2014 to 09/2014
Pridestaff Assogned to Health Plan of San Joaquin – French Camp, CA

Data entry, review claim inventory for duplicate claims, noticing payers of duplicate and paid claims via email and postal mail, review call logs for duplicate entries and resolved issues, documenting findings in the claims management system, responsible for all claims department mail, reporting TPL to the state, requesting refunds for overpayment from providers, assists fellow employees as needed.

A/R Representative12/2013 to 03/2014
California Service Bureau – Sacramento, CA

Commercial carrier follow up for Sutter Health, claim adjudication, to include review of payment and verifying that it had paid correctly, according to the contract, request contractual adjustments to balance accounts, appeal under paid claims, verify and update coverage , review denied claims for errors, print and send claims and medical records from client document imaging system, note accounts in MS4,contact patients regarding insurance needs, basically, anything necessary to obtain payment on claims.
Researched and resolved accounts payable discrepancies.
Reconciled vendor statements and handled payment complaints or discrepancies.

Appeal Follow Up Representative10/2013 to 11/2013
Robert Half assigned to Adventist Health – Roseville, CA

Follow up on second and third level appeals, contact insurance for status and additional documentation required for payment on claims, documented patient accounts in MS4.

A/R Representative03/2013 to 10/2013
Robert Half assigned to Renown Health – Reno, NV

Commercial carrier insurance follow up, claim adjudication, to include stop loss claims, contractual adjustments, verify and update insurance information, documented patient accounts in Epic, review claims, appealed denied or under allowed claims, sent documentation requested by carriers to process,.
claims, contact patients regarding insurance needs, basically, anything necessary to obtain payment on claims.
Monitored payments due from clients and promptly contacted clients with past due payments.
Researched and resolved accounts payable discrepancies.
Reconciled vendor statements and handled payment complaints or discrepancies.

Fee Office File Clerk07/2012 to 02/2013
Department of Veterans Affairs – Reno, NV

Veterans Administration Reno, NV.
Utilize electronic medical record system, index medical records verify claim forms and return inaccurate forms for revision or correction.
Verify and enter medical insurance into a pre-existing EMR system, call various private and government insurance companies to obtain information to complete records.

Sales Person07/1993 to 09/2011
Prudential California Realty – Stockton, CA

Multi-million dollar producer.
Prepared contracts, developed new business, contract negotiations, wrote print and internet advertising for marketing and sales, coverage for receptionist, collected rent, provided constant follow up, coordinated with escrow, lenders, contractors, inspectors, as well as, buyers and sellers to ensure a successful close.
Specialized in probate sales

Retail Store Manager06/1980 to 08/1988
Brown Group, Inc – Modesto, CA

Improved profitability for two stores by 100% allowing stores to remain open at a profit, and oversaw 5 employees.
Duties included hiring; training, scheduling, prepared payroll, took responsibility for product line within store.
Accountable for marking and sales, inventory, shipping and receiving, and cash balancing.
Filed and addressed employee complaints in accordance with company policies and government regulations.

Education

Associate of Occupational Studies Degree: Health Information Management2013Career College of Northern Nevada- Sparks, NVGPA: GPA: 3.83Health Information Management GPA: 3.83 Anatomy and Physiology Medical Terminology Exposure to HIPAA Insurance Billing Electronic Records Management Government Insurance Programs Medical Law and Ethics Coding ICD-9 and CPT Training

Skills

advertising, balance, Billing, contract negotiations, contracts, CPT, client, Data entry, documentation, email, forms, Government, hiring, ICD-9, imaging, Insurance, inventory, Law, marketing, Medical Terminology, mail, payroll, producer, profit, Coding, receiving, receptionist, repairs, reporting, sales, scheduling, shipping

Resume Overview

Companies Worked For:

Pridestaff Assogned to Health Plan of San Joaquin
California Service Bureau
Robert Half assigned to Adventist Health
Robert Half assigned to Renown Health
Department of Veterans Affairs
Prudential California Realty
Brown Group, Inc

School Attended

Career College of Northern Nevada

Job Titles Held:

Claims Analyst
A/R Representative
Appeal Follow Up Representative
Fee Office File Clerk
Sales Person
Retail Store Manager

Degrees

Associate of Occupational Studies Degree : Health Information Management 2013

Claims Analyst Resume Example

Resume Score: 90%

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