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Claims Examiner I Resume Example

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CLAIMS EXAMINER I
Professional Summary
Skills
Work History
Claims Examiner I08/2013 to 07/2014
Memorial Hermann Health Solutions – Houston, TX
  • Responsible for accurate and timely filing and adjudication of UB-04/institutional (CMS-1450) and professional (HCFA) claims according to ERISA, Department of Labor, HIPPA, Texas Department of Insurance, state and federal laws Analyzed, processed, researched, adjusted and adjudicated claims with the use of CPT, DRG, HCPCS, ICD 9, ICD 10 , place of service , modifiers, revenue codes, and etc, under the correct provider and member benefits using HSPS Verifier, Perfect Claim and Meditrac System Maintained quality and productivity standards as set by management Notified Physicians and Facilities by mail of rejected claims Repriced IN and OON claims using Multiplan and Life Sync repricer Assisted with preparing new benefit packages and contracts for member benefits and providers.
Human Resources and Compliance Intern01/2013 to 05/2013
Central Care Community Health Center – Houston, TX
  • Researched/drafted and assisted with the revision of various policies and procedure manuals for JCAHO compliance Performed various community outreach and marketing activities
Executive Administrative Assistant02/2012 to 09/2012
Texas Southern University – Houston, TX
  • Conserved executive's time by reading, researching, and routing correspondence; drafting letters and documents; collecting and analyzing information; initiating telecommunications on his behalf.
  • Maintained executive's appointment schedule by planning and scheduling meetings, conferences, and teleconferences.
  • Prepared all correspondence, agendas, notices, expense reports, presentations, spreadsheets, and meeting minutes and resolutions for executive and board meetings.
  • Acted as a project manager for special and ongoing projects, at the request of the Executive Team, which included planning and coordinating multiple presentations, disseminating information, and organizing IT events.
Administrative Assistant02/2010 to 04/2011
Professional Plastics INC – Houston, TX
  • Provided Administrative support for : Sales Department, Regional Manager, HR, Accounts Payable/Receivable for branch office Organized/maintained hard copy and electronic file system via Syspro database Reviewed all invoices/statements for customers and corporate office, including shipping, freight charges, taxable and non-taxable products, and prices of materials Processed client credit card payments, purchase orders, vendor invoices and issued account credits as warranted Processed and verified client credit applications via the Dun and Bradstreet Database Created new client accounts in database; Managed collections, followed-up and solicited payments on past due accounts over the phone and written correspondence for the Accounts Payable/Receivable Department.
Receptionist08/2008 to 12/2009
Law Office of Aaronson & Rash – Houston, TX
  • Performed general office duties including answering switchboard.
  • Managed client information and other legal documentation.
  • Scheduled/coordinated meetings, interviews, appointments, events and other activities for office manager and attorneys.
  • Pre-screened potential class action clients via phone interview/called clients to request and obtain documents, and entered data into data base.
Education
BS: Health Administration Public Affairs5 2013Texas Southern University- Houston, TXHealth Administration Public Affairs
Masters: Business Administration5 2015Texas A & M University- Commerce, TXBusiness Administration
Skills
Accounts Payable, administrative, Administrative support, as set, auditing, benefits, charts, CMS, oral communication, Computer literate, conferences, contracts, CPT, credit, client, clients, data base, Database, documentation, drafting, Dun, special events, fast, filing, forms, general office duties, grant proposals, HR, Insurance, legal, letters, marketing, materials, Meditech, meetings, Access, Excel, mail, office, PowerPoint, MS Word, office manager, organizing, payroll, PeopleSoft, PeopleSoft HRMS, personnel, policies, presentations, quality, QuickBooks, reading, recruitment, reporting, researching, routing, Sales, scheduling, shipping, spreadsheets, supervision, switchboard, telecommunications, phone, website, written, Excellent written
Additional Information
  • Volunteer, Leadership & Research Interests: AJROTC - 2nd Lieutenant, Robert McNair Research Program (collected, analyzed, disseminated data), won 2nd place "Shaken "Baby Syndrome". Nominated-Best Internship Performance in Health Administration, Community Field Interviewer for UTMB (collected, analyzed, disseminated data) for the Teen Pregnancy Sunny Side Research Project, Mentor for Big Brothers/Big Sisters Program, Volunteer-West Houston Medical Center, Student Healthcare Executive Association - Active Member
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Resume Overview

Companies Worked For:

  • Memorial Hermann Health Solutions
  • Central Care Community Health Center
  • Texas Southern University
  • Professional Plastics INC
  • Law Office of Aaronson & Rash

School Attended

  • Texas Southern University
  • Texas A & M University

Job Titles Held:

  • Claims Examiner I
  • Human Resources and Compliance Intern
  • Executive Administrative Assistant
  • Administrative Assistant
  • Receptionist

Degrees

  • BS : Health Administration Public Affairs 5 2013
    Masters : Business Administration 5 2015

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