I am true, visionary with a business plan to re-engineer processing tactics into a cost-effective, high, productive work flow. My mission is to always give constant communication to all, and deliver great, customer service.
Processing 30-150 medical claims for inpatient and outpatient services. Reviewing Medicare, Tricare, Medicaid claims. Pay close attention to details, before denying or paying a claim. Studied macros using COMET and UNET applicaitons for claim processing systems. Verify patient's eligibility, yearly deductibles, coinsurances, copays, and out of pockets.
Verified patient's eligibility, primary, secondary, and tertiary insurance carriers for the Mirena IUD product. Verified yearly deductibles, office copays, coinsurance, and out of pocket expenses. Worked as a third, part vendor to reprice claims on behalf of the provider. Opened and closed 75 cases daily for the providers. Ran pharmacy test claims for the Mirena IUD, to verify if the product was covered by patient's pharmacy benefits.Ensured HIPAA compliance.
Answered high call volumes, of enrolling and upselling health insurance to new members. Sold VSP DIrect individual vision insurance, also received commission weekly. Educate and informed members about their dental, medical, and vision benefits, and what services were covered under the plans. Processed medical claims for PHCS and Multiplan, repriced claims for in network and out of network providers. Verified providers' status for patients to see who accepted their plans.
Texas Scholar Academic Achievement Award
Administrative, Call center, Cash management, interpersonal skills, Crystal Reports, Healthcare Insurance, Leadership skills, managerial reports, Access, Excel spreadsheets, MS Office, Outlook, PowerPoint, Publisher, Pivot tables, Proofreading documents, quality control, Quest, Ram, Self-Starter, Switchboard, Time Management
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