ITS Claims Processor Resume Example TMG Health Inc.

ITS CLAIMS PROCESSOR

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

01/2016 to Current

ITS Claims ProcessorTMG Health Inc. - Jessup, PAMy 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.

10/2004 to 01/2016

Remote Claims ProcessorTMG Health Inc. - Jessup, PA

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.

11/1989 to 02/1996

Office SupervisorMedaphis Physician Services Inc. - Scranton, PA

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 TherapyPenn State University

Merchandising/MarketingLehigh County Communtity College

AccountingUniversity of Scranton

Resume Overview

Companies Worked For:

TMG Health Inc.
Medaphis Physician Services Inc.

School Attended

Penn State University
Lehigh County Communtity College
University of Scranton

Job Titles Held:

ITS Claims Processor
Remote Claims Processor
Office Supervisor

Degrees

Occupational Therapy
Merchandising/Marketing
Accounting

ITS Claims Processor Resume Example

Resume Score: 80%

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