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Claims Processor Resume Example

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CLAIMS PROCESSOR
Summary

With many years' experience working in Customer Service, I have the knowledge and skills of being effective for a Company that value Customer Service and Education. Seasoned Claims Processor evaluating online entry, error correction and quality control review for final adjudication of claims. Strong business and financial acumen with proven success to maintain efficient operations. Extensive knowledge of billing, collections and fiduciary management.

Skills
  • Auditing
  • Billing
  • Clerical
  • Client
  • Documentation
  • Electronics
  • Email
  • Filing
  • Finance
  • Financial
  • Forms
  • Front office
  • Government
  • Image
  • Instruction
  • Insurance
  • Letters
  • Access
  • Excel
  • Microsoft Office programs
  • Outlook
  • PowerPoint
  • Word
  • Next
  • Receptionist
  • Reporting
  • Teaching
  • Teacher
  • Telephones
  • Tutoring
  • Written
  • Written communication
  • Claims review
  • Documentation skills
  • Regulatory compliance
  • Multitasking
  • Regulatory compliance understanding
  • Data management
  • Customer service
  • Organizational skills
Experience
Claims Processor | 11/2019 to Current
Company Name - City, State
  • Working as a claims Processor as Authorization Matching, ER Claims and Claim to Authorization.
  • Analyze claims to be determine if all claims filing requirements have been met.
  • Update line items to complete adjudication of claims.
  • Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations.
  • Maintain integrity of claim auditing system by identifying and reporting potential system problems.
  • Provide examples and documentation to support findings.
  • Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.
  • Initiate written communication via web application letter writing system.
  • Built rapport and trust with injured insureds through effective customer service techniques which involved fair and prompt processing of claims.
Substitute Teacher | 09/2014 to 11/2019
Company Name - City, State
  • In absent of full time teach supervise the classroom and follow the Individualized Education Plans (IEPs) for each student.
  • Assists Special Education teachers in elementary and high schools in reinforcing efforts with children with various disabilities, including physical disabilities, visual and hearing impairments, learning disabilities, behavior disorders, emotional impairments, and mental impairments in accordance with each students' Individual Education Program (IEP); lifts and positions non-ambulatory students during the school day as instructed by the teacher and in adherence to written instruction from students' personal physicians; provides one-on-one tutoring services for students to present or reinforce learning concepts.
  • Autism Supports Professionals provide one-on-one services to individuals with autism ages 5 years through adulthood, teaching them various skills that greatly enhance their lives.
  • Engaged students and boosted understanding of material using focused instructional strategies and hands-on activities.
Admission Representative/ Scheduler | 01/2013 to 09/2014
Company Name - City, State
  • A professional position conducting interviews for federal funding programs by completing necessary forms ensuring accurate up-to-date data for demographic, insurance and financial information is entered into the EHR system.
  • Admission clerk assembles client records, verifies eligibility, and obtains authorizations as required.
  • Schedules and confirms appointments.
  • (telephonically), prepares next day's medical records, answers telephones, sends out no-show letters, and performs receptionist/clerical duties.
  • Submits all required documentation to the Department of Children and Families for Medicaid program, Economic Self- Sufficiency, and financial eligibility.
  • Administers the FP Waiver Program form and assembles immunizations' records, verifies eligibility, and obtains authorization as required.
  • Maintains advanced proficiency in Microsoft Office programs that includes (Word, Excel, PowerPoint, Access, Outlook, and Email application).
  • Knowledge in primary and specialty medical practices working as front office clerk conducting eligibility for different government programs.
  • Work as a referral coordinator, billing clerk, experience in Medicaid and Medicare.
  • Medical Records Inputs and maintains schedules within Electronics health Records (EHR) and immunization registration access to Florida shots.
  • Working with Healthy Start Coalition comprehensive program promoting optimal prenatal health developmental for pregnant women and babies in Florida.
  • Knowledge of Healthcare reform and education background in Healthcare finance.
  • Interacted sensitively, effectively, and professionally with individuals from diverse cultural, socioeconomic and educational, sexual, gender and religious orientations and backgrounds.
Education and Training
Walden University - City, State
Master of Science
Public Health, 2019

· The National Society of Leadership and Success- Member

  • Minor in Epidemiology
  • Honor Roll Fall 2020
  • 3.5 GPA
Keiser University - City, State
Bachelor of Science
Health Science, 12/2012
  • Completed coursework in Human Anatomy & Physiology, Leadership in Health Care and Health Care Ethics
  • Dean's List Honoree Fall 2011
  • 3.6 GPA
Kesier University - City
Associate of Science
Physical Therapy Assistant, 09/2002
  • Completed coursework in Exercise physiology , Clinical pathology and anatomy physiology.
  • Completed professional development in physiology.
  • 3.0 GPA
  • American Physical Therapy Association- Member
Interests

Volunteer Services: Church Youth leader, Instructor for Pathfinder Club, Church Clerk : Bilingual (English and Creole), Strong Customer Service, Billing, Collection, Communication Skills and Computer Literate, CPR certified, Typing skills 40wpm, medical terminology, insurance verification,maintaining and updating records

Additional Information
  • The National Society of Leadership and Success
  • Active listening
  • Computer skills
  • Leadership
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Resume Overview

School Attended

  • Walden University
  • Keiser University
  • Kesier University

Job Titles Held:

  • Claims Processor
  • Substitute Teacher
  • Admission Representative/ Scheduler

Degrees

  • Master of Science
    Bachelor of Science
    Associate of Science

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