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its claims processor resume example with 20+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Professional Summary

I have over 25 years of knowledge and experience both coding and processing Medical Claims, with my strongest foundation in Medicare Advantage Plans as a result of working at TMG Health for almost 12 years.

Skill Highlights
  • Strong work ethic
  • Team player with positive attitude
  • Good written and oral communication skills
  • Deadline-driven
  • Ability to work independently
  • Strong knowledge Medical Terminology
  • Experienced 1500 Claims Processor
  • Customer Service experience, including appeals and adjustments
  • ITS/Blue2 trained
  •  Knowledge of Medicare Advantage Plans

 

Professional Experience
ITS Claims Processor, 2016 to Current
XpanxionGrand Rapids, MI,
My daily duties consist of appropriately and correctly identifying errors on re-filed denied/rejected claims as they are received through General Inquiries and Adjustment Requests via the Blue2 System for Medicare Advantage 1500 claims.  It is my responsibility to reprocess claims when required, and to create DF's so that payments post correctly.  In addition I create DF's for Medicaid and Medicare Advantage ITS claims and send adjustment requests and apply host pricing when it is necessary. I also answer the HCSC Plan-to plan line on a daily basis and handle any inquiries that result from the calls received.
Remote Claims Processor, 09/2004 to 2016
Good Shepherd HospiceNorman, OK,

I have extensive experience with Facets as I have been processing Medicare 1500 claims since I started working for TMG in 2004.  In addition to processing clean claims received through Proclaim, I have also worked customer service routes, appeals, corrected claims, non-traditional, and MSP files for various clients including American Progressive, Unicare, Wellcare, Carillion, VNS, NHP, MAPD, Advantage and ABCBS. I have a strong familiarity with the CMS website as well as several local carrier sites as a result of my processing background.

Office Supervisor, 10/1989 to 01/1996
Medaphis Physician Services Inc.City, STATE,

Although my position initially was a medical coder for various provider specialties, I was also responsible for helping to  implement an electronic submission system for commercial and government insurance programs claim forms.  I was promoted to Office Supervisor after 3 years and had over 15 direct reports for which I handled job delegations, scheduling, and payroll.  I was responsible for meeting with clients regularly and providing accounts receivable reports on a monthly and annual basis.

Education and Training
: Occupational Therapy, Expected in to Penn State University - ,
GPA:
: Merchandising/Marketing, Expected in to Lehigh County Communtity College - ,
GPA:
: Accounting, Expected in to University of Scranton - ,
GPA:

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Resume Overview

School Attended

  • Penn State University
  • Lehigh County Communtity College
  • University of Scranton

Job Titles Held:

  • ITS Claims Processor
  • Remote Claims Processor
  • Office Supervisor

Degrees

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