Medical Claims Processor resume example with 7+ years of experience
Flexible Customer Service Representative offering over 8 years of success in resolving customer concerns and inquiries. Versed in accurately documenting call details and preparing reports. Committed to providing helpful answers and relevant information to retain clients. Calm and composed in stressful situations with successful record of reducing customer dissatisfaction through acknowledgment, decisive communication and focused solutions. Current Medical Claims Processor promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic. Hands-on professional offering a keen understanding of data confidentiality and HIPAA regulations. Highly trained Medical Coder knowledgeable in AMA and the CMS coding rules.
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- Stayscurrent on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Reviews claims for accuracy before submitting for billing.
- Inputs data into the system, maintaining accuracy of provider coding information and reported services.
- Sent clinical request and missing information letters to obtain incomplete information.
- Bases payment or denials of medical claims upon well-established criteria for claims processing.
- Evaluates pending claims to identify and resolves problems blocking auto-adjudication.
- Assistd claimants, providers and clients with problems or questions regarding claims.
- Collects payments, processes receipts and informs policyholders of outstanding balances.
- Order Entry for new/refill medications.
- File documentation as required by pharmacy regulations.
- Respond to customer inquiries as necessary.
- Fill drug kits under direct supervision applying accuracy and aseptic technique.
- Match preprinted label and delivery manifests with a source document.
- Locate medication from pharmacy supply area, count out, and package in correct system, including blister packs and vials.
- Pre-package medications according to standard procedures.
- Assist in other phases of computer operations including billing procedures.
- Clean all equipment and work areas.
- Check equipment for calibration and safety.
- Rotate stock as required.
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
- Resolved customer inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks.
- Used a computerized system, responded to Medicaid member inquiries in a call center environment using standard scripts and procedures.
- Gathered information, assessed caller needs, researched and resolved inquiries, and documented calls.
- Provided clear and concise information regarding member eligibility, along with assisting callers with completing their Medicaid applications and providing updates on their application status
- Followed documented policies and procedures including call handling and escalations.
- Overall acted as an advocate for Medicaid members to ensure their needs are met.
- Delivered patient information, appointment results and insurance information to other office staff for reporting and billing purposes.
- Cooperated with Medicare, Medicaid and private insurance providers to establish relationships and resolve billing issues.
- Expertly assigned charges and payments for medical procedures.
- Provided beneficiaries with information about plan benefits and eligibility determinations.
- Handled new enrollments by entering customers' data and reviewing information.
- Responded to member questions regarding plan benefits and provisions.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Referred unresolved customer grievances to designated departments for further investigation.
- Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
- Explained and educated members about the terms of their insurance plan, and how health care reform impacts their coverage.
- Calculated member's rates and compare to other policy rates, and benefits.
- Recommended different plans that would meet members needs.
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Resume Overview
School Attended
- Tidewater Medical Staffing
- First Colonial High School
Job Titles Held:
- Medical Claims Processor
- Medical Data Entry Specialist
- Call Center Customer Service Representative
- Medicare Customer Service Representative
Degrees
- Certified Medical Assistant
- High School Diploma
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