ANTHONY CLARK
Dallas,TX
Summary
Accounts Receivables, Medical Claims Processor and Customer Service skills with extensive experience and knowledge for a period of over 15 years in the medical claims industry. Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
17
17
years of professional experience
Work History
LOGISTICS SPECIALIST
SAFARILAND
10.2023 - 08.2024
- Coordinate with in-house sales team to promote accurate and timely processing of protective bullet proof vests orders for law enforcement and military customers
- Scan orders into computer and track shipments across multiple channels
- Maintain inventory control over products and supplies
- Trained and supervised new trainees monthly.
Full Time Student
Colorado Technical College
12.2022 - 10.2023
- Studies in business topics such as finance, marketing, accounting, basic business law and business management.
Appeals Specialist
Shared Services Center
12.2022 - 05.2023
- Collaborated with other team members & departments to gather necessary documentation and evidence to support the appeals process.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately under tight deadlines.
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
- Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
Part Time Dock Worker
Saia LTL Freight
03.2022 - 01.2023
- Load/Unload Freight using forklift, manual/electric pallet jack and Secure freight appropriately
- Read and Interpret Shipping Labels
- Use both Hand Held Scanners, Mounted Computer
- Hazmat Training, Manual and Machine Wrap.
Accounts Receivable Specialist
One Call LLC
03.2021 - 09.2022
- Investigate Workman's Comp claims for coverage and payment benefits on submitted claims, denials and written appeals
- Outbound calls to multiple insurance companies for updates on submitted claims, denials and written appeals
- Worked aging claims 120 days or more
- Collaborated with Workman's Comp vendors such as Sedgewick on claims processes and benefits.
Accounts Receivable Specialist
Springstone LLC
07.2018 - 01.2021
- Investigated behavioral and substance abuse medical claims for inpatient billing for Medicare, Medicaid, and Commercial claims using UB04
- Ensure patient's medical file and demographics is accurate and up to date for billing purposes
- Gather all necessary medical documentation to submit corrected claims and written appeals or medical claims review for payment
- Worked aging claims list via spreadsheet 180 days or more
- Collect, Post, and manage patient account payments and payment plans
- Daily Inbound/Outbound calls to and from insurance carriers and patients in regards to claims and payment status.
Accounts Receivable Specialist
University of Florida Jax Physicians
03.2017 - 06.2018
- Inbound/Outbound calls to and from insurance companies and patients regards to submitted claims
- Follow-up on claim denials and written appeals
- Posted patient payments and setup patient payment plans when necessary
- Prepare and submitted physician medical claims to insurance companies using HCFA 1500.
Part Time Cleaning Crew Member
Pricilla's Inspirational Cleaning Services
12.2015 - 06.2018
- General cleaning of office buildings
- Help with equipment maintenance.
Accounts Receivable Specialist
Baptist Health Medical Billing Group
08.2014 - 11.2015
- Reviewed denied medical claims for Medicare, Medicaid, and Commercial coverages
- Submitted all medical documentation, records, referral, and prior authorizations proof for denied medical claims and written appeals
- Follow-up and collected on missed payments and misapplied payments in addition to posting both insurance payments and patient payments
- Daily Inbound/Outbound calls and insurance websites to and from insurance carriers and patients.
Medical Claims Processor
Firstsource LLC
04.2012 - 08.2014
- Reviewed and processed Medicare, Medicaid and Commercial medical claims for adjudication per individual state guidelines and client contracts.
Medical Claims Processor
Humana Inc.
03.2007 - 03.2011
- Reviewed and processed Medicare, Medicaid and Commercial medical claims for adjudication
- Received inbound calls from patients for payment processing
- Critical claims review for high dollar and aging claims 150 days or more.
Education
Associate of Science - Business Administration And Management
Colorado Technical College
Colorado Springs, CO07.2024
Skills
- Medical Terminology
- Appeals Writing and Reviews
- UB04 & HCFA 1500 Claim Reviews
- Medicare & Medicaid Claim Denials
- Commercial Claims and Denials
- Payment Adjudication and Payment Posting
- Workman's Comp
- Inbound/Outbound customer service calls to and from insurance carriers
- Microsoft Word
- Excel Spreadsheet
- Outlook
- Epic
- Allscripts & other company-based applications and systems
Timeline
LOGISTICS SPECIALIST
SAFARILAND
10.2023 - 08.2024
Appeals Specialist
Shared Services Center
12.2022 - 05.2023
Full Time Student
Colorado Technical College
12.2022 - 10.2023
Part Time Dock Worker
Saia LTL Freight
03.2022 - 01.2023
Accounts Receivable Specialist
One Call LLC
03.2021 - 09.2022
Accounts Receivable Specialist
Springstone LLC
07.2018 - 01.2021
Accounts Receivable Specialist
University of Florida Jax Physicians
03.2017 - 06.2018
Part Time Cleaning Crew Member
Pricilla's Inspirational Cleaning Services
12.2015 - 06.2018
Accounts Receivable Specialist
Baptist Health Medical Billing Group
08.2014 - 11.2015
Medical Claims Processor
Firstsource LLC
04.2012 - 08.2014
Medical Claims Processor
Humana Inc.
03.2007 - 03.2011
Associate of Science - Business Administration And Management
Colorado Technical College
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