Anitra Clark
Sugar Land,TX
Summary
Seasoned professional with 19 years of experience in medical insurance claims and billing, seeking a role as a Health Insurance Specialist. Expertise in Medicaid reimbursement, claims processing, and reporting. Skilled in administrative support within clinical settings, ensuring efficient operations.
Overview
19
19
years of professional experience
Work History
Claims Processor Analyst
Harris Health
01.2016 - 01.2024
- Analyzed and processed Medicaid claims, ensuring accurate inventory control and prompt resolution of issues
- Conducted investigations into adjusted claims and implemented solutions efficiently
- Authenticated and facilitated the payment of medical claims, including bill negotiations and error monitoring to ensure compliance with insurance coverage
- Assessed claim compensability, applying state law and adhering to company and CMS guidelines to administer benefits
- Escalated complex adjusted claims to management for further review and resolution
- Completed the settlement and closure of adjusted claims within granted authority limits
- Managed a systematic diary for claims monitoring and maintained documentation to accurately reflect ongoing claim activities
- Compiled detailed monthly reports to highlight trends and support informed managerial decision-making
- Participated in special projects, effectively addressing a range of management requests.
- Documented all prior authorization information in patient profiles, includingapproval dates and prior authorization numbers.
- Processed referrals and submitted clinical supporting documentation to insurance carriers
Sr Claims Examiner
Community Health Choice
10.2009 - 01.2016
- Evaluated and executed Medicaid claim procedures, achieving precise inventory management through expedited resolutions
- Developed and delivered comprehensive monthly reports, identifying critical patterns to aid in managerial decision-making
- Contributed to various special projects, responding adeptly to multifaceted management directives.
Administrative Staff Assistant
Community Health Choice
10.2007 - 09.2009
- Assisted Claims Manager with daily office tasks such as reporting trends for incoming claims inventory via excel spreadsheets
- Pull paper claims for distribution for claims examiners and team lead
- Provide feedback for staff meetings and projections
- Completed clerical tasks such as research for Claims Manager and Director along with similar duties pertaining to the incoming claims inventory.
Executive Assistant to Clinical Director
Palladium for Surgery
08.2004 - 09.2007
- Managed comprehensive administrative duties for the Clinical Director, optimizing efficiency in daily tasks and operations
- Coordinated the credentialing of new medical graduates, enhancing their integration into fellowship and internship programs
- Delivered consistent administrative support to the Medical Director, ensuring uniformity in operational procedures and continuity.
Education
Some college in Psychology -
University of Houston-Downtown
Houston, TX05.1997
Some college in Biology -
University of North Texas
Denton, TX05.1995
Skills
- Medical Claims Processing
- Research
- Claims Adjustment Processing
- Icd-10
- Customer Service
- Data Analysis Skills
- Leadership
- Medical Coding
- Team Management
- Human Resources
- Hipaa
- Medical Terminology
- NCQA Standards
- Project Management
- Managed Care
- Medical Billing
- Hospital Experience
- Utilization Management
- Communication and Organizational Skills
- Medical Records
- Multi-tasking
- Communication
- Time Management
- Microsoft Outlook
Timeline
Claims Processor Analyst
Harris Health
01.2016 - 01.2024
Sr Claims Examiner
Community Health Choice
10.2009 - 01.2016
Administrative Staff Assistant
Community Health Choice
10.2007 - 09.2009
Executive Assistant to Clinical Director
Palladium for Surgery
08.2004 - 09.2007
Some college in Psychology -
University of Houston-Downtown
Some college in Biology -
University of North Texas