MEDICAL DOCUMENT REVIEWER, TENURED ASSOCIATE (MDR 1)
Resourceful Healthcare Professional with strong organizational capabilities and excellent data entry skills. Flexible and poised under pressure. A proven talent in problem solving, producing accurate and sound results in a fast-paced work environment. Able to maintain a high level of professionalism while exhibiting leadership qualities.
Summary of Qualifications
Strong Verbal and Written Ability
Claims Review/Processing Procedures
Single Case Agreements
Veteran Document Processing
Medical Document Reviewer, Tenured Associate (MDR 1)02/2016 to 07/2016 Integrity Staffing-DOMA Technologies a Subsidiary of Health Net Federal Services
Processed medical documents from healthcare providers for Veterans.
Maximized productivity by performing highly accurate data entry of sensitive information and reviewing other correspondence received from healthcare providers.
Reduced aged Veteran Documents by 80%.
Contacted healthcare providers to collect medical data to forward to the Veteran Administration.
Identified, analyzed and resolved various document and scheduling issues.
Contacted healthcare providers to confirm appointment status
Utilized Communication Proficiency, customer/client focus, organizational skills/problem solving and technical knowledge in order to process veteran's information.
Grievance and Appeals Analyst I12/2013 to 08/2015 Anthem/Amerigroup Corporation
Addressed concerns submitted by members, appointed representatives and providers.
Resolved non-routine customer and partner concerns directly with regulators and employers, reported findings to the appropriate business partners and functional areas to drive process and product enhancements.
Recorded and tracked projects in excel.
Researched and processed written correspondence for appeals.
Reviewed documents for authorizations.
Obtained and processed documentation received with errors from medical providers.
Cross Trained Claims Analyst.
Claims Analyst03/2012 to 12/2013 Anthem/Amerigroup Corporation
Prepared, reviewed and submitted health claims to state Medicaid agencies.
Performed eligibility checks for Medicaid providers.
Handled claims procedures for clients and guided them on submitting additional documents.
Gathered, compiled, and analyzed data necessary for claims submission.
Identified claim files and secured appropriate medical documentation.
Accurately interprets, understands and applies processing instructions and fee schedules for assigned markets when processing claims.
Performed Claim inquiries to reduce duplicate billing and prevent provider from a negative status.
Investigation of documentation received with errors.
Customer Service Representative09/2010 to 03/2012 Fidelis Billing
Appropriately handled telephone inquiries with patients and health insurance carriers.
Processed claims using Claims Adjudication System.
Reviewed and drafted email correspondence.
Corresponded with third party insurance and other healthcare providers.
Internship04/2010 to 09/2010 Fidelis Billing
Filed, faxed and copied Ambulance Reports.
Obtained Health Insurance information.
Researched information using available resources.
Verified data including HIPAA documentation.
Assistant Director03/2000 to 06/2009 Noah's Ark Daycare
Supervised a team of eight full-time employees.
Trained, encouraged, and mentored staff.
Worked actively with teachers to maintain high curriculum standards.
Examined learning materials.
Managed day-to-day activities.
Associate of Applied Science: Medical Administrative Assisting2011Bryant & Stratton CollegeVirginia Beach, VA