ANDREA BANFIELD
Lancaster,CA
Summary
Versatile, highly qualified, and dedicated Healthcare Insurance Claims Specialist Candidate with a wide range of successful hospital bill/claims processing, contracts, benefits, provider services and medical data analysis experience. Adept at analyzing various healthcare data, collaborating with vendors, preparing financial reports, Consistently maintains compliance with various medical insurance/billing policies and regulations while managing a high volume of database entries for inventory and hospital billing initiatives. Currently seeking Healthcare Insurance Claims Specialist position by demonstrating the following skills, qualifications, and experience.
Overview
18
18
years of professional experience
Work History
Inbound Provider Service Representative
UnitedHealth Group
08.2023 - Current
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Handled escalated calls efficiently, finding satisfactory resolutions for both providers and the company alike.
- Responded to provider requests for adjustments, pricing and participation reviews
- Prioritized tasks effectively during peak call periods, ensuring optimal productivity without compromising service quality.
- Maintained detailed records of provider interactions, ensuring proper follow-up and resolution of issues.
Accounts Receivable Clerk
Optum360/Northwell Health
11.2018 - 11.2022
- Responsible for working several patient accounts daily while preparing itemized bills, UB04, and medical records to be sent to various insurance carriers for payment
- Handle all matters pertaining to patient billing and medical insurance claims processing.
Clinical Support Specialist
Coram Healthcare/CVS Infusion Pharmacy
06.2012 - 11.2018
- Assisted pharmacists by entering prescription data and new orders to be reviewed while contacting patients to discuss medication and supply deliveries, as well as dispensing IV antibiotics via HCN
- Collaborate with nurses regarding patient care, manage accurate deliveries by communicating with compounding staff, and work with billing personnel to verify insurance coverage of drug therapies
- Programmed Curlin and CADD pumps for use in patient homes, as well as enter prescription data to obtain co-payments.
Clinical Service Representative
New York Blood Center
04.2006 - 02.2012
- Performed quality reviews and ensure that blood center maintains FDA compliance regarding donation procedures, as well as data processing and hospital billing
- Managed inventory and HLA/Granulocyte order processing, as well as audited nursing department and assisted with data control, microfilming, and retention tube processing.
Education
Medical Billing & Specialist Diploma -
Hunter Business School
Certified Pharmacy Technician -
National Healthcare Association
Skills
- Healthcare Insurance Claims
- Plan/Benefit Administration
- Process Improvement
- EMR Software Implementation
- Insurance Claims Processing
- Medical Terminology
- Record/File Maintenance
- Account Management
- Provider/Vendor Relations
- Bill/Claims Examination
- Database Administration
Timeline
Inbound Provider Service Representative
UnitedHealth Group
08.2023 - Current
Accounts Receivable Clerk
Optum360/Northwell Health
11.2018 - 11.2022
Clinical Support Specialist
Coram Healthcare/CVS Infusion Pharmacy
06.2012 - 11.2018
Clinical Service Representative
New York Blood Center
04.2006 - 02.2012
Medical Billing & Specialist Diploma -
Hunter Business School
Certified Pharmacy Technician -
National Healthcare Association