Insurance Claims Validator resume example

• COB and Insurance Eligibility claim processing, which includes: primacy rules for priority payment, integration of benefits, Medicare training, secondary insurance, end stage renal disease.
• Established & understanding of reason codes: dependent not covered, payment prior to coverage, terminated coverage, lapse of coverage.
• Established & understanding of Medical terminology: Medical Terminology Certification.
• Established understanding of terms, example: advanced beneficiary notice, prior authorization, timely filing, non participation provider, participating provider, remittance advice.
• Documentation of each account for accuracy in reference to details of eligibility.
• Being in compliance with HIPAA on all accounts.
• Documented entire validation process, noting changes or alterations completed.

CURRENTLY WORK AT THIS EMPLOYER: FIRST JOB BEFORE MOVING TO INSURANCE VALIDATION POSITION

• Contacting attorney's offices, representatives of insurance carriers, insurance carrier adjusters, and workmen's compensation carriers for medical claims to determine if there is potential case for third party liability.
• Established and updating all account information to ensure that all information is accurate for future referencing.
• Performance compliance with HIPAA on all accounts.
• Performing coordination of benefits with auto and third party auto carriers.
• Performing documentation of each account for accuracy in reference to details for managing account and medical expenses.
• Establishing and obtaining information from attorney's offices, insurance adjusters, and workmen's compensation by letters for determination of interests on when necessary.
• Managing over 35 calls per day.
• Worked closely with team members to deliver project requirements, develop solutions and meet deadlines

• Politely assisting customers and responding resourcefully to requests and request concerns.
• Issuing credit(s) and refunds after approval by management. Placing items in correct area for reporting on defective or damage items resulting from shipping process.
• Processing and managing over 100 purchases per day and handling transactions through POS system.
• Increasing customer service by decreasing waiting times.
• Stocking, rotating, and removing items near expiration date from all locations to ensure items are used within recommended time frames.
• Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
• Maintained clean personal appearance of store when by stocking shelves, organization and arrangement of merchandise.

• Developed and initiated monthly payment plans for customers on outstanding accounts, both small and large accounts.
• Communicating with customers about their account(s) and collecting outstanding balances.
• Researched and resolving any questions or concerns on account balances for customers immediately.
• Posting payments, providing change back when necessary and issuing receipts.
• Clerical duties and tasks, including: scheduling, directing phone calls, filing, batching mail, weekly postage outgoing mail for office, taking messages for appropriate staff members, and greet visitors.
• Maintaining attorney database accounts weekly by keeping accounts in good standing.
• Bi-weekly attorney billing.
• Cashiered, balancing daily cash drawer, and cash handling.
• Receiving and routing medical records to appropriate files for scanning.
• Maintained current and accurate medical records for over 300 juvenile court cases per year.
• Creating and preparing legal drafts by organizing and assembling information for legal documents and forms.
• Professional customer service in friendly, efficient manner ,
• Scanned paper documents into computer and assigned identification numbers to simplify tracking process updating records with new information.
• Sorted all paperwork and documents alphabetically and according to dates and significance.
• Updated records with new information.
• Assisting with typing, data entry and answering incoming calls as required.