claims auditor resume example with 20+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Religion:
Military service:
:
Professional Summary
Detail-driven accounting professional experienced in examining and analyzing accounting records, financial statements and financial reports to assess accuracy and compliance with generally accepted accounting principles and standards. Proven to analyze accounting processes, identify deficiencies and formulate and implement corrective action plans to achieve compliance and mitigate risk.
Skills
GAAP Accounting Practices
Financial Reporting & Analysis
General Ledger Accounting
Accounts Payable & Receivable
Accounts Reconciliation
Effective Time Management
Analytical
Strong Organizational Skills
Dedicated Team Player
SAP
Quickbooks
Microsoft Office
Effective and Professional Communication
Financial Projections
Report Preparation
Judgement and Decision Making
Critical Thinking and Analysis
Financial Statements
Business Operations and Forecasting
Tax Return Preparation
Journal Entries
Balance Sheet
Work History
CLAIMS AUDITOR, 05/2016 - 08/2021 Metroplus Health Plan – Newark, NJ,
Conducted detailed audits to ensure claims were processed in accordance with Medicaid compliance and company policies and procedures
Conducted post payment claims audits on adjudicated medical bills
Utilized all available resources to maximize identification and recovery of overpayments and complied with all company policies/procedures and state and federal laws during the investigation process
Performed administrative tasks required for the invoicing and recovery process
Created and maintained files in accordance with management policies and guidelines by obtaining and attaching all appropriate documentation to clearly identify an audit trail for the audit performed
Researched, documented, and reported audit error findings to leadership
Provided a detailed summarized analysis report to report audit errors identified
Reviewed and analyzed error trends in processing
Managed multiple projects to make sure deadlines were met within assigned budgets
Ensured accurate monthly, quarterly and year to date performance reporting of all audit related reports
Prepared and downloaded claim samples for audit team.
Provided high level of professionalism when speaking with customers or responding to emails to promote company's dedication to service.
Researched issues related to claims processing to identify origins and implement corrective solutions.
STAFF ACCOUNTANT, 09/2014 - 05/2016 2-10 Home Buyers – Phoenix, AZ,
Prepared balance sheets, profit and loss statements and other financial reports
Analyzed and verified information for accuracy and reported, identified, and corrected errors made by both internal and external personnel
Maintained and updated records and reports for profit and loss, taxes, liabilities and assets
Prepared payments by accruing expenses, assigning account numbers, requesting disbursements, and reconciling accounts
Answered accounting and financial questions by researching and interpreting data
Supported timely monthly, quarterly, half-year, and year-end financial close, including assigned journal entries, balance sheet account reconciliations, accruals, and overall maintenance of all operational management accounts
Prepared special financial reports as requested by management
Protected organization's value by keeping information confidential.
Performed testing of audit areas for fixed assets and accounts payable.
Increased efficiency, support and documentation of accounting processes by creating detailed schedules for journal entries.
Projected future costs and revenues by closely analyzing ongoing costs, business operations and incoming revenue in balance sheets.
Greeted patients providing a high level of customer service
Obtained benefit quotes from insurance
companies for services
Verified insurance eligibility and confirmed and collected co-pays as applicable
per insurance requirement
Completed insurance claims billing and claims payment process
Researched
and followed up on denied and incorrectly processed insurance claims
Troubleshot non-payments
or delayed payments
Followed up on unpaid patient bills
Collected, reviewed, and organized billing
paperwork
Sent medical records when requested
Reconciled electronic and other payments when
received from both insurance companies and self-pay patients
Provided accurate data entry into billing
software
Performed accounting and finance duties such as accounts receivable and payable, reconciling
bank statements and ledger accounts, and creating budgets and forecasts for management
Managed
and maintained accurate records of clinic patients to ensure patients are called for due follow-up
Kept
supplies ready by inventorying stock, placing orders and verifying receipt
Performed other related office
duties as assigned.
CUSTOMER SERVICE PROFESSIONAL, 11/2007 - 09/2014 American International Group – San Antonio, TX,
Provide operational support to customers based on assigned accounts to increase retention rate
Effectively handled high-volume of customer orders
Processed, clarified and confirmed customer
purchase orders using SAP
Communicated with customers on all order related topics (incl
Checked inventory and release orders on stock
arrival (bi-weekly report, action, delivery reliability)
Initiated and supervised rush orders
Supported
the order management team
Implemented process improvements
Actively engaged with customers
to monitor customer satisfaction
Advocated internally working with key partners to address customer
concerns/satisfaction issues.
Education
Master of Business Administration: BUSINESS ADMINISTRATION in ACCOUNTING, Expected in 07/2016 - KELLER GRADUATE SCHOOL oF MANAGEMENT - Addison, IL GPA: Status -
Bachelor of Business Administration: BUSINESS ADMINISTRATION in ACCOUNTING, Expected in 12/2013 - DEVRY UNIVERSITY - Addison, IL GPA: Status -
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