(555) 432-1000,
Montgomery Street, San Francisco, CA 94105

Flexible professional known for being proficient in multiple healthcare software's as well as all Microsoft and having exemplary customer service skills. Smart Medical Claims Processor capable of assessing claims and assigning payment dependent upon established criteria. Seasoned Claims analyst Insurance Specialist with excellent planning and problem solving abilities. Offering 6+ years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.

  • Insurance billing
  • Customer service
  • Problem resolution
  • Planning and coordination
  • Relationship development
  • Supervision
  • Communications
  • Process improvement
  • MS Office
  • Regulatory compliance understanding
  • Medical terminology
  • Insurance claims management
  • Claim validity determination
  • Proficiency in Microsoft
Education and Training
Concorde Career College Tampa, FL, Expected in 01/2015 Certificate of Medical Billing : Medical Billing And Coding - GPA :
St. Petersburg College Clearwater, FL Expected in 06/2012 Associate of Science : Buisness Management - GPA :
Sickles High School Tampa, FL Expected in 06/2008 High School Diploma : - GPA :
Chubb - Medical Claims Analyst
Minneapolis, MN, 03/2018 - 05/2020
  • Denial and appeal specialist Claims expert ICD-10 trainer.
  • Understanding and complete knowledge of process of the revenue cycle.
  • Working hand in hand with doctors and insurance companies.
  • Understanding the different policies and guidelines for each commercial payer.
  • Attention to detail and knowledgeable.
  • Based the payment or denials of medical claims upon well-established criteria for claims processing.
  • Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
  • Efficiently and effectively processed a large volume of medical claims on a daily basis.
  • Reviewed claims for accuracy before submitting for billing.
  • Inputted data into the system, ensuring that provider coding information and reported services were correct.
  • Used contract notes and processing manual to correctly apply group-specific classifications to claims.
  • Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
  • Reviewed administrative guidelines whenever questions arose during the processing of claims.
  • Sent clinical request and missing information letters to obtain incomplete information.
Community Health System - Medical Billing Specialist II
Venice, FL, 10/2016 - 12/2017
  • Prepared billing statements for patients, ensuring correct diagnostic coding.
  • Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.
  • Reviewed and verified benefits and eligibility with speed and precision.
  • Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
  • Remained up-to-date with all insurance requirements, including details of patient financial responsibilities, fee-for-service and managed care plans by participating in training programs.
  • Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
  • Accurately coded diagnostics and prepared billing statements for patients.
  • Completed appeals and filed and submitted claims.
  • Meticulously tracked and resolved underpayments.
  • Precisely completed appropriate paperwork and system entry regarding claims.
  • Performed quality control of data entry system to verify proper posting of claims and payments.
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
  • Applied payments, adjustments and denials into medical manager system.
Cvs Health - Medical Billing Representative
Pittsburgh, PA, 06/2014 - 09/2015
  • Submitted refund requests for claims paid in error.
  • Maintained timely and accurate charge submission through electronic charge capture, including billing and account receivables (BAR) system and clearing house.
  • Accurately posted and sent out all medical claims.
  • Posted charges, payments and adjustments.
  • Applied payments, adjustments and denials into medical manager system.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Verified proper coding, sequencing of diagnoses and procedures.
  • Tracked and recorded status of delinquent accounts and sent follow-up letters to request payment.
  • Meticulously tracked and resolved underpayments.
  • Completed appeals and filed and submitted claims.
  • Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
  • Confirmed patient demographics, collected copays and verified insurance.
Activities and Honors

Certified by AAPC for Medical Billing since January 2015.

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School Attended

  • Concorde Career College
  • St. Petersburg College
  • Sickles High School

Job Titles Held:

  • Medical Claims Analyst
  • Medical Billing Specialist II
  • Medical Billing Representative


  • Certificate of Medical Billing
  • Associate of Science
  • High School Diploma

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