Alexis Edgerton
Warren,MI
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously.
Overview
6
6
years of professional experience
Work History
Medical Claims Adjuster
Concentrix
Remote
09.2021 - 01.2024
- Analyzed policy details along with supporting documents provided by healthcare providers to make informed decisions on claims approvals or denials.
- Evaluated new software tools that improved productivity levels while maintaining accuracy standards.
- Resolved complex claims issues for expedited processing and resolution.
- Assisted in the creation of departmental procedures and guidelines to maintain consistency across all team members'' work quality standards.
- Managed large volume of medical claims on daily basis.
- Identified and resolved discrepancies between patient information and claims data.
- Reviewed provider coding information to report services and verify correctness.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Generated reports on medical claims processing activities and results.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Processed insurance payments and maintained accurate documentation of payments.
- Efficient in ICD-10, ICD-9, HCPCS and CPT coding.
- Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
Home Health Caregiver
Lajoy Home Health Care
Warren, MI
09.2017 - 08.2021
- Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
- Assisted patients with daily living activities, improving their overall quality of life.
- Performed light housekeeping duties to maintain a clean, safe, and organized living space for patients.
- Ensured timely transportation of patients to appointments or social engagements, enhancing their ability to maintain an active lifestyle outside the home setting.
- Enhanced patient comfort by providing compassionate and attentive care.
- Assisted disabled clients to support independence and well-being.
- Promoted a positive atmosphere within the home setting by engaging patients in meaningful conversation and activities.
- Coordinated meal planning based on dietary requirements and preferences, contributing to optimal nutritional intake for each patient.
- Traveled to clients' homes to complete healthcare services and promote continuity of care.
- Administered prescribed medications accurately, ensuring proper dosage and adherence to schedules.
- Provided physical assistance for mobility, promoting independence and safety in the home environment.
- Supported emotional well-being through companionship services such as reading aloud or playing games together during downtime periods.
Team Member
Menchies Frozen Yogurt
Warren, MI
05.2018 - 08.2018
- Kept work areas clean, organized, and safe to promote efficiency and team safety.
- Learned all required tasks quickly to maximize performance.
- Worked scheduled shifts and remained available to work during coworker absences, holidays, and busy periods.
- Contributed to team success by completing jobs quickly and accurately.
- Worked different stations to provide optimal coverage and meet production goals.
Education
High School Diploma -
05.2017
Skills
- ICD-10 Coding Knowledge
- HIPAA compliance awareness
- Teamwork orientation
- Continuous learning mindset
- Data Entry Efficiency
- Coding Familiarity
- Claims Analysis Expertise
- Insurance Regulations Compliance
- Medical terms and procedure knowledge
- HIPAA
- Medical Terminology
- Insurance Claims
- Decision-Making
- Claims Processing
- Claims adjustment
- Insurance Verification
- Healthcare Common Procedures Coding System (HCPCS)
- HCPCS Knowledge
- Coding Proficiency
- CPT Coding Proficiency
Timeline
Medical Claims Adjuster - Concentrix
09.2021 - 01.2024
Team Member - Menchies Frozen Yogurt
05.2018 - 08.2018
Home Health Caregiver - Lajoy Home Health Care
09.2017 - 08.2021
Enterprise High School - High School Diploma,