Amanda G. Powell
Fayetteville,NC
Summary
Health insurance professional with extensive experience in claims adjudication, ensuring compliance with industry standards and regulations. Consistently delivers accurate and timely claim determinations, contributing to team efficiency and positive outcomes. Reliable team player with adaptability and focus on achieving results, possessing strong analytical and problem-solving skills.
Overview
25
25
years of professional experience
Work History
Health Insurance Claims Adjudicator
Spectrum Medical Billing Services
02.2024 - Current
- Researched and resolved complex medical/behavioral health claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Ensured accuracy of claim payments by conducting thorough audits and identifying areas for improvement.
- Responded to correspondence from insurance companies.
- Followed up on denied claims to verify timely patient payment and resolution.
Site Coordinator/Medical Assistant
Carolina Sleep & Respiratory/PMC
04.2013 - Current
- Coordinate and schedule appointments.
- Obtain pre-certification and/or pre-authorization if required.
- Record vital signs and take medical history.
- Market to physician offices and communicate with providers.
Referral Specialist/Medical Receptionist
Rapid Care
04.2013 - 09.2013
- Coordinate and schedule referrals with the appropriate specialty care providers.
- Trained new receptionists in ICD-9/CPT coding. Audited their work to ensure that entries were recorded correctly.
- Investigated denied claims, corrected claims with errors and assisted in collections of accounts receivable.
Medical Receptionist
Physician’s Urgent Care
08.2004 - 07.2007
- Proficient in ICD-9/CPT coding and transcribing medical records.
- Prepared nightly deposits and financial reconciliation reports.
- Responsible for collections of co-payments, deductibles, co-insurance and old balances.
Medical Receptionist
Lafayette Clinic
06.2002 - 08.2004
- Prepared new patient charts and updated patient demographics.
- Maintained a working knowledge of medical terminology and utilized to record and interpret patients’ information.
- Demonstrated ability to maintain composure and work efficiently preserving patient confidentiality.
Medical Receptionist
First Med Urgent Care
04.2001 - 05.2002
- Assisted with registration of new patients/verified insurance benefits and eligibility.
- Insured proper use of ICD-9 and CPT coding.
- Handled daily cash flow.
Pharmacy Service Associate
CVS Pharmacy
12.1999 - 05.2001
- Prepared prescriptions by retrieving, counting, measuring and labeling prescription bottles.
- Maintained customer/patient confidentiality.
- Assisted customers with questions and problems.
Education
Biology With Concentration in Health Occupations
Methodist University
Fayetteville, NC01.2013
Medical Coding and Billing, Dental Office Management
FTCC
Fayetteville, NC01.2002
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Terry Sanford Senior High
Fayetteville, NC01.2000
Skills
- HIPAA compliance
- Claims analysis
- Claims processing
- Policy interpretation
- Electronic claims processing
- Workload prioritization
- Self motivation
- Teamwork and collaboration
- ICD-10 codes
- EMR systems
- Microsoft Office
- Medicare and Medicaid
Timeline
Health Insurance Claims Adjudicator
Spectrum Medical Billing Services
02.2024 - Current
Site Coordinator/Medical Assistant
Carolina Sleep & Respiratory/PMC
04.2013 - Current
Referral Specialist/Medical Receptionist
Rapid Care
04.2013 - 09.2013
Medical Receptionist
Physician’s Urgent Care
08.2004 - 07.2007
Medical Receptionist
Lafayette Clinic
06.2002 - 08.2004
Medical Receptionist
First Med Urgent Care
04.2001 - 05.2002
Pharmacy Service Associate
CVS Pharmacy
12.1999 - 05.2001
Medical Coding and Billing, Dental Office Management
FTCC
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Terry Sanford Senior High
Biology With Concentration in Health Occupations
Methodist University
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