Summary
Overview
Work History
Education
Skills
Timeline
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April Reed

Summary

Seeking an opportunity in a growing organization to work as an enthusiastic and reliable professional in leadership.

Overview

16
16
years of professional experience

Work History

Provider Claims Support

Centene
Atlanta, GA
03.2022 - Current
  • Paid or denied medical claims based upon established claims processing criteria.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Reviewed provider coding information to report services and verify correctness.
  • Claims reprocessing for physicians and Hospital.
  • Claims adjustment for coding issues, plan errors, eligibility, coordination of benefits and authorization.

Customer Service Representative II

Centene
Atlanta, GA
09.2014 - Current
  • Answered average of 30 calls, emails and faxes per day, addressing customer inquiries, solving problems and providing product information.
  • Work over 7 health plans.
  • Provide assistance providers regarding website registration and navigation.
  • Provide providers with health plan guidelines.
  • Respond to telephone or written correspondence inquires from providers within established timeframes unitizing current reference material and available resources.
  • Check eligibility and benefits for healthcare providers.



Billing Specialist

Kool Smiles
Atlanta, Ga.
07.2009 - 09.2014
  • Bill 200 to 350 patient daily.
  • Bill for 3 to 4 different states.
  • Prepares retro review for paper claims.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
  • Accurately posted and sent out all medical claims.
  • Submitted electronic/paper claims documentation for timely filing.

Commercial Verification Specialist

Kool Smiles
09.2009 - 08.2011
  • Contact various commercial payers and verity patient eligibility.
  • Assist dental clinic in with process of ensuring patients is active for benefits.
  • Creating payer plans which assist billing with regulations on billings.
  • Create professional atmosphere on ensuring correct billing treatment.
  • Work with excel spreadsheets, in home systems such as boomerang and Citrix and general office duties.

Medicaid Verification Specialist

Kool Smiles
Marietta, Ga.
06.2009 - 09.2009
  • Verified patients’ eligibility and claims status with insurance agencies.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Precisely evaluated and verified benefits and eligibility.
  • Precisely completed appropriate claims paperwork, documentation and system entry.

Education

Some College (No Degree) -

University of Phoenix
Tempe, AZ

Skills

  • Medical terminology expert
  • ICD-10 (International Classification of Disease Systems)
  • Billing and collection procedures expert
  • Records management professional
  • Excellent problem solver
  • Resourceful and reliable worker
  • Close attention to detail
  • Familiar with commercial and private insurance carriers
  • Patient chart auditing ability
  • Understands insurance benefits
  • Office management professional
  • Excellent verbal communication
  • Customer service and support
  • Claims Processing
  • Processing medical claims

Timeline

Provider Claims Support

Centene
03.2022 - Current

Customer Service Representative II

Centene
09.2014 - Current

Commercial Verification Specialist

Kool Smiles
09.2009 - 08.2011

Billing Specialist

Kool Smiles
07.2009 - 09.2014

Medicaid Verification Specialist

Kool Smiles
06.2009 - 09.2009

Some College (No Degree) -

University of Phoenix

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April Reed