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

Seasoned Medical Insurance Specialist with excellent planning and problem solving abilities. Offering 20+ 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.

Skills
  • Insurance claims management
  • ICD-10 coding
  • Insurance collections
  • Insurance claims
  • Front desk operations
  • Referral verification
Education and Training
Jordan Vocab Columbus, GA, Expected in 01/1993 GED : - GPA :
Experience
Atria Senior Living Group, Inc. - Private Child Caregiver
Fort Worth, TX, 06/2020 - Current
  • Organized and planned age-appropriate lessons involving reading, crafts, music and movement.
  • Balanced schedules to provide optimal rest, play and educational periods.
  • Enforced rules to teach manners and maintain safe environment.
  • Helped prepare meals, snacks and refreshments for children and accounted for individual dietary needs and restrictions.
  • Discussed new developments, misbehavior and concerns with parents or guardians.
  • Secured indoor and outdoor premises to protect children under care.
  • Led children in tidying up, handwashing and toileting to teach responsibility.
  • Delivered direct, supervised care to groups of children between ages 1 and 8.
International Bancshares Corp - Customer Service Representative
Lawton, OK, 06/2019 - 06/2020
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.
  • Documented conversations with customers to track requests, problems and solutions.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
  • Fielded customer complaints and queries, fast-tracking them for problem resolution.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.
  • Handled billing related activities focused on medical specialties.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
  • Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Examined claims, records and procedures to grant approval of coverage.
  • Updated patient financial information to promote accurate record keeping.
Kaiser Permanente - Office Assistant
Honolulu, HI, 02/2016 - 08/2018
  • Coordinated vendors, timelines and budgets for events.
  • Selected décor and event materials fitting clients' requests and vision.
  • Assessed event success and identified improvement areas through client feedback.
  • Initiated negotiations with vendors and subcontractors to meet event budget.
  • Designed and maintained spreadsheets documenting vendor, facility and guest information.
  • Oversaw event logistics, venue scheduling and accommodations.
  • Directed florists, photographers, musicians and ceremony participants during pre-ceremony, ceremony and post-ceremony events.
  • Hosted large groups by engaging with attendees during annual events.
  • Planned, coordinated and executed weddings and special events.
Arkansas Urology - Insurance Specialist
Pine Bluff, AR, 01/2012 - 02/2017
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
  • Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
  • Accurately processed large volume of medical claims every shift.
  • Inputted data into the system, maintaining accuracy of provider coding information and reported services.
  • Reviewed claims for accuracy before submitting for billing.
  • Reviewed administrative guidelines whenever questions arose during processing of claims.
  • Based 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.
  • Sent clinical request and missing information letters to obtain incomplete information.
  • Reviewed received payments for accuracy and applied to intended patient accounts.
  • Maintained up-to-date understanding of insurance payment practices.
  • Filed and submitted insurance claims.
  • Handled third-party insurance processing tasks to assist patients.
  • Performed routine quality assurance audits to promote data integrity.
  • Expertly assigned charges and payments for medical procedures.
  • Assessed medical codes on patient records for accuracy.
  • Verified final claim submissions by comparing account charges with documentation.
  • Documented and filed patient data and medical records.
  • Recorded, stored and reported medical coding information to create statistics of healthcare encounters.
  • Coordinated communications between patients, billing personnel and insurance carriers.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Organized information for past-due accounts and transferred to collection agency.
  • Reviewed all claims for accurateness and appropriateness.
  • Handled billing for full complement of practice providers.
  • Completed and submitted appeals for denied claims.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Used software system to manage provider schedules and keep calendar organized practice.
  • Used various health record indexes and storage retrieval systems to manage medical billing.

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Resume Overview

School Attended

  • Jordan Vocab

Job Titles Held:

  • Private Child Caregiver
  • Customer Service Representative
  • Office Assistant
  • Insurance Specialist

Degrees

  • GED

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