ASHANTI KENT
Macon,GA
Summary
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 5+ years of experience. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
6
6
years of professional experience
Work History
Claims Associate
Avesis
Remote , GA
12.2022 - Current
- Handles various inbound or outbound provider calls which include researching, resolving, and documenting issues.
- Handles RCM authorization and intake changes required for claims and billing processing within 48-hour turn-around time frame.
- Analyzes data and determines if Avesis claims processing guidelines have been followed correctly by researching plan, eligibility, and patient authorization information.
- Tracks claim detail errors and communicates to up-line management for coaching and training purposes.
- Participates in and contributes to performance improvement activities.
- Participates in special projects and performances other duties as assigned.
- Maintained accurate and up-to-date records of claim information for future reference.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
- Analyzed and addressed escalated claims to resolve issues quickly.
Inpatient Claims Processor
Oxford
Remote, GA
07.2021 - 12.2022
- Processing incoming inpatient hospital claims
- Researching, investigating, reviewing, negotiating, and processing inpatient claims
- Applying rates per special processing instructions
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Provided support during internal and external audits, ensuring accurate representation of company's claim history.
- Assisted in updating company guidelines for consistent application of policies across all claims processed.
- Monitored changes in legislation that could potentially impact the way claims are processed or paid out by insurance companies.
- Identified fraudulent claims through thorough investigation and documentation of findings
- Negotiated settlements with policyholders, balancing their needs with the financial interests of the company
Claims Associate
Navient
Remote , GA
12.2019 - 07.2021
- Reviewing, researching, investigating, negotiating, and adjusting health insurance claims
- Understanding multiple products and different levels of benefits
- Applying benefits according to specific processing instructions
- Tracking benefit maximums
- Working spreadsheet to clear aged work
- Adjudicates claims and adjustments as required.
- Resolves claims edits and suspended claims.
- Maintains and updates required reference materials to adjudicate claims.
- Provides backup support to other team/group members in performance of job duties as assigned.
- Participated in cross-functional projects and initiatives, leveraging claims expertise to support company-wide objectives.
- Reduced claim resolution time by improving communication between departments and prioritizing urgent cases.
- Improved team performance by providing ongoing training and support for Claims Associates on best practices and procedures.
- Managed high-volume claim caseloads, ensuring accurate documentation and adherence to company policies.
Data Entry
Novitex
Remote, GA
04.2018 - 11.2019
- Keyed claims into system for processors to handle
- Contact or forward claims to different departments to collect data needed to force claim through system
- Sent claims to RMO to be filmed for tracking purposes
- Created and maintained data entry logs to track data entry activities.
- Developed and implemented data entry operations.
- Typed 50 wpm, allowing for fast and accurate data entry.
Education
Associate of Arts - Psychology
East Carolina University
Greenville, NC02.2023
High School Diploma -
Central Highschool
Macon, United States07.2019
Skills
- Keyboarding and basic computer experience
- In-depth claims knowledge
- Claims analysis and reviewing
- Detail-oriented
- Data entry
- Spreadsheet
- Word Processing
- Basic math skills
- Claims Processing
- Claims Investigation
- Insurance Claims Review
- Claims management
- URAC standards
Timeline
Claims Associate
Avesis
12.2022 - Current
Inpatient Claims Processor
Oxford
07.2021 - 12.2022
Claims Associate
Navient
12.2019 - 07.2021
Data Entry
Novitex
04.2018 - 11.2019
Associate of Arts - Psychology
East Carolina University
High School Diploma -
Central Highschool
Similar Profiles
Amanda AeschlimannAmanda Aeschlimann
Government Network Provider Recruiter at AvesisGovernment Network Provider Recruiter at Avesis
M'LYNN CONVERYM'LYNN CONVERY
Dental/Vision Claims Processor at AvesisDental/Vision Claims Processor at Avesis
Amy TerrazasAmy Terrazas
Billing and Eligibility Specialist at AvesisBilling and Eligibility Specialist at Avesis
Monica GarrettMonica Garrett
Crew Chief at Servpro of MaconCrew Chief at Servpro of Macon
Donnovan DiazDonnovan Diaz
Customer Support Specialist at Eagleview TechnologiesCustomer Support Specialist at Eagleview Technologies