Antoinette McIntosh
Plainfield,New Jersey
Summary
Proven track record of efficiently processing a high volume of claims while ensuring accuracy and compliance. Excellent problem-solving and communication skills with a commitment to providing superior customer service. Proficient in working with complex medical and legal documents and utilizing multiple computer systems to maintain accurate records.
Overview
16
16
years of professional experience
Work History
Workers Compensation Claims Adjuster
Genex
Piscataway, NJ
05.2022 - Current
- Examined claim forms and other records to determine insurance coverage
- Communicated regularly with claimants via phone calls, emails, or letters regarding status updates or additional documentation requests
- Handled difficult conversations professionally while maintaining composure during high-stress situations
- Oversee worker's compensation claims
- Researched and analyzed policy contracts to verify the proper payment of claims.
Senior Case Management Representative
Qual-Lynx
Piscataway, NJ
08.2018 - 05.2022
- Resolved issues through careful research and follow-up with customers
- Gathered, organized, and input information into a digital database
- Managed daily operations, including scheduling staff, monitoring workflow, and ensuring compliance with established policies
- Train new hires on company policies and procedures regarding diverse situations
- Interacted with customers regularly to maintain and enhance relationships
- Working closely with nursing staff and patient care, scheduling labs, and pre-admission testing.
Clinical Intake Coordinator
QualCare
Piscataway, NJ
09.2009 - 08.2018
- Actively participated in team meetings, trainings, and workshops related to patient intake processes
- Scheduled and coordinated patient intake appointments, verified insurance coverage, and obtained necessary authorizations
- Determined patient eligibility by reviewing patient documentation for completeness and accuracy.
Claims Examiner
QualCare
Piscataway, NJ
05.2008 - 09.2009
- Collect, verify, record, and process client demographics, insurance payments, and referral information
- Claim investigation
- Utilize effective problem-solving techniques when dealing with complex situations or challenging behaviors from clients
- Managed heavy workloads by prioritizing tasks according to urgency or importance
- Utilized critical thinking skills to research complex issues and develop creative solutions for challenging cases
- Applied knowledge of healthcare regulations, laws, policies, procedures, guidelines, and best practices when making decisions related to claim adjudication
- Processed claims for ARC/NYC-911 programs
- Handled complaints and grievances using negotiating and problem-solving skills
- Conducted research to gather information supporting or refuting the claim.
Education
Medical Insurance Billing & Coding -
DeVry University
05-2024
Master of Science (M.S.) in Health Care Management -
American InterContinental University
10-2021
Bachelor of Healthcare Management in Health Services Administration -
American InterContinental University
01-2020
Associate in Arts (A.A.) in Business Administration -
American InterContinental University
08-2018
Skills
- Claims File Management Processes
- Problem Solving
- Determining Staffing Needs
- Claims Processing
- Risk Assessment
- Workers Compensation Claims Specialist
- Legal Compliance
- Insurance Policy Coverage Knowledge
- Medical Terminology
- Microsoft Word
- Claims Investigation
- Legal Knowledge
- Claims Management
Awards
The National Society of Leadership
References
References available upon request
Timeline
Workers Compensation Claims Adjuster
Genex
05.2022 - Current
Senior Case Management Representative
Qual-Lynx
08.2018 - 05.2022
Clinical Intake Coordinator
QualCare
09.2009 - 08.2018
Claims Examiner
QualCare
05.2008 - 09.2009
Medical Insurance Billing & Coding -
DeVry University
Master of Science (M.S.) in Health Care Management -
American InterContinental University
Bachelor of Healthcare Management in Health Services Administration -
American InterContinental University
Associate in Arts (A.A.) in Business Administration -
American InterContinental University