Claims Examiner III Resume Example
Analyst with extensive experience in conducting research of various written and electronic materials. Proficiencies include reconcile discrepancies in data and information and using database software to input, organize, track and retrieve data.
|
|
Ebms － Billings , MT
Determines level of reimbursement based on established criteria, provider contract, plan and employer group provisions. Read and comprehend various technical documents such as policies, procedures, standard regulations, technical reports and contracts. Processes all claims eligible or ineligible for payment accurately and conforming to quality, production standards and eligibility, misrepresentation, potential fraud, medical necessity and appropriateness of cares for medical clinic and hospital claims.. Identify, analyze, and evaluate situations or problems to determine and implement appropriate courses of action. Responsible for applying, reviewing, and analyzing information against claims submission by Providers and Hospitals. Researches and resolves unusual high technical or complicated problems from internal and external customers/clients/members disputes and appeals claims. Validates hold codes or suspend status to ensure claims are paid in accordance to policy benefits and providers agreements. Researches and resolves telephone action items routed from CSR
Concentra － Saugus , CADischarged outgoing patient and schedule future appointment. Intake new patient information and verified insurance eligibility. Identify information data materials and resources needed to complete a project or assignment. Introduce change in a positive manner to generate support for the change and minimize the perceived impact on others. Work on multiple tasks or parts of tasks simultaneously to ensure timely completion. Work independently on projects or assignments. Review and edit materials for proper content, format, grammar, punctuation, and sentence structure. Prepares and review patients chart for next day services. Review patient's accounts for accuracy and completeness for billing data. Conduct research of various written and electronic materials. Performing routine follow-up calls to insurance company to determine the status of claims. Obtain patient's insurance information from patients to generate claims.
Clean Harbors, Inc. － Livermore , CAReconciles billing and invoices, checks balances, produces statements and maintains client files. Research account specifics to complete necessary follow up actions. Contact patients/insurance companies on unresolved claims. Use electronic mail software to input organize, track, and retrieve data. Use spreadsheet software to compile, compute, organize, and present tables, graphs, and chars. Post adjustment request and explanations timely as identified. Ensures timely collection of outstanding A/R and perform a verity of clerical and accounting functions to resolve billing problems of submitted claims. Processes claim, denials, suspension, appeals and aging report to determine the appropriate follow-up action. Send out collection letters on primary and secondary insurance company.
W.R. Berkley Corporation － Washington , DCVerify patient eligibility for treatment through DEERS check, hospital card, etc. Ensures all treatment requested by the physician has been scheduled and reschedules appointments when necessary. Maintain records and filing notes, lab reports, resident charts and other documents as required. Obtains and reviews medical records of patients prior to scheduled appointment. Facilitate meetings and discussions in a manner that ensures the meeting and discussion stays focused on the intend topic and encourages active participation by all attendees. Assures proper completion and filing of forms in records prior to forwarding to medical records room. Directs visitors and telephone calls to appropriate clinics and personnel.
Department Of The Army － City , STATE
Review and processes application for various types of government benefits, such as military pay, health care, processed travel vouchers and military veteran's benefits. Ensure utmost accuracy on all voucher claims, verifies qualifying information, such as employment, health and financial status to determine the appropriate level of need. Determine the needs and granting or declining vouchers accordingly. Conduct interviews with claimants to assess needs, verify application information or request further information, if necessary. Posts, verifies, balances, extends and reconciles financial statements. Processes financial transactions including matching and checking invoices; processing payments and travel reimbursements; maintaining petty cash and financial filing systems; and responding to inquires regarding payment of invoices.
Bachelors Degree in Business Accounting (BSB/Accounting), University of Phoenix, GPA 3.48
Company Name － City, State
Served as Executive Administrative specialist for the Division Commanding General and staff. Prepared official memorandums for the entire division staff members. Conducted protocol functions during VIP visits and special ceremonial events. Prepared award recommendations, personnel evaluation reports and correspondence. Coordinated travel arrangements and maintained the monthly calendar for the Division Commanding General and his Chief of Staff. Processed Security Clearance requests and Courier card applications. Prepared General staff briefing slides and organization charts.
Medical Office Assistant
US Army Administrative Specialist certificate
US Army Professional leadership certificate
- Process and review Medical Claims and clients health benefits
- Review medical records and insurance contracts to ensure accuracy
- Analyzed financial statements and provided business accounting practices
- Proficient in MS OS suite
DISCLAIMER
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
How this resume score could be improved?
Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:
- Formatting
- Word choice
- Measurable results
- Strong summary
- Typos
Resume Overview
School Attended
- University of Phoenix
Job Titles Held:
- Claims Examiner III
- MedicalOffice Assistant
- Billing Representative
- Medical Assistant Clerk
- Financial Administrative Clerk/Voucher Examiner GS-9
- Executive Administrative Specialist
Degrees
- Bachelors , Business Accounting
Similar Resumes
