Alycia Sherman
Medical Claims Investigator
Carlisle,PA
Summary
Qualified Claims Representative versed in investigating claims and verifying information. Excellent customer service, time management, and multitasking abilities. Knowledgeable about handling insurance claims, drafting correspondence, and coordinating files. Offering 6 years of insurance experience.
Overview
6
6
years of professional experience
Work History
Medical Claims Investigator
MultiPlan
03.2021 - Current
- Analyzed claim overpayments, conducted outreach to providers and other health insurance companies to secure recovery of incorrectly paid claims, and accurately documented findings and refunds for client billing and reporting.
- Utilized SQL advanced queries to increase funding for potential recoveries.
- Achieved production goals for 2022 by submitting $1.2 million in recoveries
- Examined claims forms and other records to determine insurance coverage.
Recovery Analyst
Discovery Health Partners
07.2020 - 02.2021
- Analyzed more than 50 claims daily by identifying potential recovery opportunities.
- Accomplish $1,733,610.43 in recoveries from one client in eleven months.
- Administrated organization's database by using database management system to organize and manage data.
- Researched billing errors and discrepancies to initiate corrective action.
Medical Claims Representative
Gallagher Bassett
03.2020 - 05.2020
- Managed workload of more than 50 claims weekly while examining diaries and supporting other team member's desk loads.
- Utilized specific vendor and state filling criteria for workers compensation.
- Processed weekly benefit payments and maintained accurate documentation.
- Researched and resolved complex medical claims issues to support timely processing.
Claims Assistant
Gallagher Bassett
12.2018 - 03.2020
- Research missing claimant information by collaborating with 15 adjusters while completing extensive workers compensation state forms across various jurisdictions and Defense Base Act (DBA) claims.
- Performed quality control and assurance processes on reliable inventory data to ensure accurate reporting.
- Prepared files, letters and notices.
- Scheduled medical appointments and medical transportation if needed.
Customer Service Scheduling Specialist
Geisinger Holy Spirit
08.2017 - 11.2018
- Analyzed customer's queries and issues by responding to more than 60 + calls daily.
- Operated Electronic Medical Records (EMR) systems, maintaining and protecting health information of 500 + patients; processed medical information into EMR systems including EPIC and Facets.
- Submitted requests and changes into scheduling system and created accurate customer service schedules.
- Trained staff on operating procedures and company services.
Education
Master of Science - Health Informatics Administration
University of Maryland Global Campus
Adelphi, MD08.2023
Diploma - Medical Insurance Coding
Blackstone Career Institute
Allentown, PA01.2021
BBA - Health Administration
Central Penn College
Summerdale, PA06.2020
Associate of Arts - Healthcare Management
Harrisburg Area Community College
Harrisburg, PA05.2017
Skills
- Data Research & Analysis
- Quality Assessment & Assurance
- EMR / EHR
- Carrier Coordination
- Trained in EPIC & Facets
- Accurate Documentation
- Structured Query Language
- Medical Terminology Expert
- Revenue Cycle Solutions
- Microsoft Office Suite
- Claims Auditing
- Customer Service
Timeline
Medical Claims Investigator
MultiPlan
03.2021 - Current
Recovery Analyst
Discovery Health Partners
07.2020 - 02.2021
Medical Claims Representative
Gallagher Bassett
03.2020 - 05.2020
Claims Assistant
Gallagher Bassett
12.2018 - 03.2020
Customer Service Scheduling Specialist
Geisinger Holy Spirit
08.2017 - 11.2018
Master of Science - Health Informatics Administration
University of Maryland Global Campus
Diploma - Medical Insurance Coding
Blackstone Career Institute
BBA - Health Administration
Central Penn College
Associate of Arts - Healthcare Management
Harrisburg Area Community College