To secure a position with a company that will allow me to effectively demonstrate my skills and knowledge in a professional environment with the opportunity for growth and advancement.
Completion of 15 hours in the Mastery Program for Customer Service, granted by Home Care Medical.
Promoted from Claims Processor to Senior Benefit Analyst within one year of employment at Claim Management Services.
Promoted to most valuable account endorsed by Claim Management Services.
Utilized all training options while employed at St. Lukes Medical Center, to obtain Cardiac Technician status.
Often trained new employees during employment at St. Lukes Medical Center and Claim Management Services.
Receive and process DME orders received from clients via fax, phone and email.Verify medical necessity with providers, and request any needed additional documentation per Medicare and Medicaid guidelines. Release orders for delivery after insurance verification medical necessity process has been completed. Submit order(s) to warehouse for delivery.
Responsible for the timely processing of health insurance claims.
Investigate denials when deemed a reimbursable service.
Verify patient benefits and effective date of coverage, updating patient demographics as needed.
Utilize tracking report to follow up on unpaid claims.
Write appeal letters for denied or underpaid claims, utilizing and submitting supporting documentation.
Cover receptionist duties as needed.
Review, process and make appropriate payment on health claims for self-insured companies.
Provide explanation of plan benefits to members, group administrators, and providers.
Investigate accident/injury claims.
Review medical records for the determination of pre-existing conditions.
Interact with members, group administrators, providers and attorneys to resolve claim errors or omissions, and investigate disputed denials and/or payments.
Coordinate benefits with secondary insurance carriers.
Anatomy and Physiology, Medical Aspesis, Medical Terminology, and Professional Development.
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