Anicia Hohl
Lynchburg,Virginia
Summary
Healthcare professional with over 15 years in claims processing, eligibility verification, and data entry. Expertise in reviewing medical claims, verifying member benefits, and resolving discrepancies. Skilled in quality reviews and compliance with policies and regulations. Proven ability to manage high-volume workloads with accuracy and confidentiality.
Overview
18
18
years of professional experience
Work History
Eligibility Verification Processor
Kaiser Permanente
Hyattsville, Maryland
08.2017 - 06.2026
- Verified member eligibility, enrollment status, and coverage information to ensure accuracy.
- Processed member enrollments, terminations, and eligibility updates within established timeframes.
- Researched and resolved discrepancies by reviewing member information and coordinating with departments.
- Retrieved daily hospital census reports; entered newborn demographic data accurately per procedures.
- Maintained accurate member records while safeguarding protected health information per HIPAA regulations.
- Performed quality checks and data validation to correct discrepancies in membership information.
- Collaborated with internal teams to resolve membership issues and enhance customer service.
- Managed high-volume data entry tasks with strong attention to detail and productivity.
Medical Claims Processor
Kaiser Permanente
Silver Spring, Maryland
07.2014 - 08.2017
- Verified and evaluated member eligibility and benefits for accurate claims processing and compliance.
- Reviewed health records and authorizations to confirm coverage prior to claims payment.
- Processed healthcare claims, ensuring accuracy, completeness, and adherence to established policies.
- Researched and resolved claims discrepancies by analyzing eligibility and authorization details.
- Collaborated with cross-functional teams to address claims issues per CMS guidelines and policies.
- Identified complex claims issues and escalated cases needing further review for timely resolution.
- Maintained confidentiality and regulatory compliance while handling sensitive information in a high-volume environment.
Data Entry Clerk
Kaiser Permanente
Silver Spring, Maryland
08.2008 - 07.2014
- Processed high-volume professional and institutional medical claims, consistently meeting productivity and quality standards.
- Reviewed and validated claim information to ensure compliance with company policies and eligibility requirements.
- Identified and resolved billing discrepancies by analyzing member, provider, and claim data before final processing.
- Reviewed reimbursement claims for international emergency medical services, ensuring completeness of receipts and documentation.
- Converted foreign currency to U.S. dollars for accurate reimbursement calculations on international claims.
- Compiled and submitted ambulance claims to vendors, ensuring documentation met all requirements for timely processing.
- Maintained confidentiality and accuracy while handling sensitive claims information in accordance with HIPAA regulations.
Education
Bachelor of Science - Commerce
Asian Development Foundation College
Philippines03-1997
Skills
- Medical Claims Processing
- Medical Records & Authorization Review
- Claims Research & Discrepancy Resolution
- Member Eligibility & Benefits Verification
- Enrollment Processing & Verification
- Healthcare Data Entry & Data Integrity
- Quality Assurance
- CMS & HIPAA Compliance
- Protected Health Information (PHI) Management
- Cross-Functional Collaboration
Timeline
Eligibility Verification Processor
Kaiser Permanente
08.2017 - 06.2026
Medical Claims Processor
Kaiser Permanente
07.2014 - 08.2017
Data Entry Clerk
Kaiser Permanente
08.2008 - 07.2014
Bachelor of Science - Commerce
Asian Development Foundation College