Medical Claims Processor Resume Example
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MEDICAL CLAIMS PROCESSOR
Accomplishments
- Supervised ten HR interns and provided assistance in resume building, training and career path development.
- Promoted to supervisor after two years of employment.
- Developed departmental handbooks that presented criteria on how to navigate various departments.
Professional Summary
Human Resource Generalist, Medical Biller, & Administrative Assistant who is an expert communicator and negotiator with strong conflict resolution skills. Extensive background in recruitment and retention, mediation and records management, customer service, medical billing, and administration support.
Skills
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Work History
Medical Claims Processor, 02/2013 to 06/2013
Kemper – Booth , AL
Kemper – Booth , AL
- Monitoring itemized billings for excessive charges, duplications, unbundling, and medical coding.
- Determining prior authorization/precertification of services paid via system and/or health services.
- Requesting and reviewing medical records as needed for basic information to validate billing information.
- Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.
- Meeting and exceeding performance measurements for Claim Examiners as required by department to meet regulatory compliance.
- Ability to operate PC-based software programs or automated database management systems.
- Strong communication skills with excellent analytical and problem- solving skills.
- Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-9, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge.
Administrative Assistant, 06/2010 to 01/2013
Ridout Lumber Company – Little Rock , AR
Ridout Lumber Company – Little Rock , AR
- Drafted meeting agendas, supplied advance materials and executed follow-up for meetings and team conferences.
- Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information.
- Served as central point of contact for all outside vendors needing to gain access to the building.
- Maintained an up-to-date department organizational chart.
- Supplied key cards and building access to employees and visitors.
- Managed the day-to-day calendar for the company's senior director.
- Received and screened a high volume of internal and external communications, including email and mail.
- Cooperated with Medicare, Medicaid and private insurance providers to resolve billing issues.
- Managed daily office operations and maintenance of equipment.
Human Resource Specialist, 07/2000 to 03/2007
Maximus, Inc. – Rochester , NY
Maximus, Inc. – Rochester , NY
- Explained human resources policies and procedures to all employees
- Worked closely with HR business partners to facilitate year-end talent reviews and articulate team strengths
- Created job descriptions to attract a targeted talent pool within the market wage range
- Managed over 100 personnel files according to policy and federal and state law and regulations
- Generated employee tracking reports each month Offered consistent payroll disbursement with accurate record keeping of employee PTO and vacation accruals
- Helped training and development staff with all aspects of training coordination
- Organized employee schedules, department phone lists and business card orders.
Education
Associate of Science: General Studies, 2013
Pima Community College - City, State
Pima Community College - City, State
- Coursework in Business Management
- Coursework in Financial Accounting
- Coursework in Health Services Administration and Business
- Coursework in Healthcare Administration
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Resume Overview
School Attended
- Pima Community College
Job Titles Held:
- Medical Claims Processor
- Administrative Assistant
- Human Resource Specialist
Degrees
- Associate of Science : General Studies , 2013
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