ALANA FELDER
Douglasville,GA
Summary
Seasoned claims processing specialist with over a decade of experience, combining a 3-years background in complex insurance claims management with 7-years in customer service excellence. Expert in detailed analysis, discrepancy resolution, and strict adherence to organizational protocols. Skilled in cultivating collaborative relationships with clients and teams, ensuring successful outcomes. Committed to applying this blend of expertise and collaborative approach to contribute significantly to a dynamic organization's goals.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Senior Claims Examiner
Optum
10.2023 - Current
- Provide expertise or general claims support by reviewing, researching, investigating, processing and adjusting claims based on standard operating procedures on CPS.
- Authorize appropriate payment or refer claims to investigators for further review.
- Analyze and identify trends and provides reports as necessary.
- Consistently meet established productivity, schedule adherence, and quality standards.
- Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates).
- Review and apply member benefit plans and provider contracts, Pricing, CMS rate letter, SCA’s etc. to ensure proper benefits and contract language is applied to each claim.
Claims Processor II
Point32Health
02.2022 - 06.2023
- Executed in-depth analysis of claims to guarantee precision and adherence to regulatory standards, ensuring meticulous compliance with established protocols
- Resolved95% of claim discrepancies within24 hours, ensuring accuracy and comprehensive code compliance
- Rigorously applied verification policies to prevent fraud, demonstrating a keen understanding of risk management
- Efficiently processed over1,000 claims monthly, upholding a98% compliance rate with industry guidelines
- Streamlined claims processes, increasing efficiency by30% and boosted revenue by15%
Claims Processor II
Wps Health Solutions
03.2021 - 01.2023
- Efficiently processed and accurately entered claims data, achieving99% accuracy in insurance eligibility and ICD-10 coding application
- Resolved90% of claims with edit codes within48 hours through rigorous review
- Surpassed company benchmarks by processing20% more claims than average
- Completed40+ hours of advanced training annually, elevating claims processing skills
Technical Support Consultant
Apple
01.2019 - 02.2021
Education
Chattahoochee Technical College
Skills
- Medical Terminology
- ICD-9, ICD Coding
- Athenahealth, EPIC
- HCPC & CPT Proficiency
- Process Improvement
- Time Management
- EOB/Remittance Reading
- Revenue Cycle Billing
- Leadership
- Quality Assurance
- Data Entry and Computer Navigation
Certification
U.S. Security Clearance
Timeline
Senior Claims Examiner
Optum
10.2023 - Current
Claims Processor II
Point32Health
02.2022 - 06.2023
Claims Processor II
Wps Health Solutions
03.2021 - 01.2023
Technical Support Consultant
Apple
01.2019 - 02.2021
Chattahoochee Technical College