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medical claims credentialing specialist resume example with 5+ years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Professional Summary

Effective Medical Claims/Credentialing Processor with 5+ years experience in strong background building rapport with providers to discuss any status or denials. Motivated and Driven performer equipped to handle multiple administrative tasks effectively, Including but not limited to, any and all Medical credentialing, verifications of insurance, medical claims billing, insurance payment posting, and client assistance. Exemplary worker with highly investigative and organized skills when processing everything. Also trained in positive behavioral support with a background in RBT experience.

Skills
  • Telephone etiquette
  • Health insurance industry knowledge
  • Medical terms and procedure knowledge
  • Thorough claims reviews
  • Knowledgeable in Microsoft (Excel, Power point, Word, etc)
  • Insurance claims processing
  • Reporting skills
  • Account management
  • Self-motivated professional
  • Good listening skills
  • Adaptability
  • Cultural awareness
  • Supervision
  • Planning and Coordination
  • Patient Assistance
  • Behavioral Health
  • Training & Development
  • Critical thinking
  • Quickbooks 2011-12
  • Current on Microsoft office
  • Networking and Partnership Development
  • CPR, BLS, FIRST AID CERTIFIED Cert#: 00RI6II
  • Trained in Positive Behavior Supports as a BT
Work History
08/2018 to 03/2022 Medical Claims & Credentialing Specialist U.S. Physical Therapy | Canton, MI,
  • Conducted primary source verifications such as background checks and board certifications.
  • Received and evaluated applications to look for missing and inaccurate information.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Enrolled providers and Medicaid, Medicare and private insurance plans.
  • Prepared records for site visits and file audits.
  • Pre-screened resumes prior to sending to corporate hiring managers for consideration.
  • Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency.
  • Improved office efficiency by effectively managing internal communications and correspondence.
  • Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
  • Oversaw HR needs for 200 employee operation across 7 locations.
  • Submitted electronic/paper claims documentation for timely filing.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Managed large volume of medical claims on daily basis.
  • Responded to correspondence from insurance companies.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Evaluated accuracy and quality of data entered into agency management system.
  • Reported policy changes and company conditions affecting customer satisfaction.
  • Responded to customer calls swiftly to resolve issues and answer questions.
  • Spent ample time with each customer, verbally reviewing and explaining documents for client comprehension.
  • Verified client insurance policies with great understanding of their policy and accepted procedures
  • Identified, researched and resolved billing variances to maintain system accuracy and currency.
  • Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
  • Posted insurance payments into software system
  • Mental health coding experience
  • Organized multiple spreadsheets for the office needs as well as insurance companies
  • Left to be closer to family in Fort Worth
05/2018 to 08/2018 Insurance Verifications Specialist Fresenius Medical Care And Dialysis | City, STATE,
  • Reviewed patient cases per week and verified insurance coverage information.
  • Observed strict procedures to protect sensitive patient information, including medical records and payment data.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Verified client information by analyzing existing evidence on file.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
09/2016 to 03/2018 Medical Claims Representative Christus Trinity Mother Frances Hospital | City, STATE,
  • Managed large volume of medical claims on daily basis.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Reported policy changes and company conditions affecting customer satisfaction.
  • Responded to correspondence from insurance companies.
  • Collected customer feedback and made process changes to exceed customer satisfaction goals.
  • Gathered forms, copied insurance cards and verified patient information for billing and insurance filing.
  • Located errors and promptly refiled rejected claims.
  • Trained new employees on multiple medical billing programs and data entry software.
Education
Expected in 05/2024 to to Associate of Science | Medical Office Management Tyler Junior College, Tyler, TX, GPA:

Courses Taken:

  • Medical Terminology
  • Professional Writing
  • Psychology
  • Business Computer Tech (Excel, Word, Power point, etc.)
  • Musical Arts
  • Scholarship Recipient


Next Course:

  • A&P
Expected in 03/2017 to to GED | TJC West Campus, Tyler, TX, GPA:
Certifications
  • Completed CNA Training - Mar 2017
  • Completed Mental Health First Aid Training- Aug 2019
  • Completed CCBHC Training- May 2020
  • Completed PMAB Training- Oct 2020

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Resume Overview

School Attended

  • Tyler Junior College
  • TJC West Campus

Job Titles Held:

  • Medical Claims & Credentialing Specialist
  • Insurance Verifications Specialist
  • Medical Claims Representative

Degrees

  • Associate of Science
  • GED

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