ASHLEY CREWS
Du Quoin,Illinois
Summary
Seasoned Claim Technician with a track record of reducing high-risk claims costs, honed at Blue Cross Blue Shield of IL. Leverages strong analytical skills and a positive attitude to enhance claims accuracy and compliance. Proven expertise in claims analysis and time management, ensuring customer service excellence and operational efficiency. Highly dedicated and organized professional with experience in the insurance industry. Expertise in claims processing, policy evaluation, claims review, and data entry. Proven track record of accurately and efficiently processing high volumes of claims while adhering to strict company policies. Focused on providing superior customer service and maintaining positive customer relationships.
Experienced with managing and resolving insurance claims efficiently. Utilizes analytical skills and industry knowledge to assess and process claims accurately. Track record of maintaining high standards in customer service and problem resolution.
Claims professional with extensive knowledge in insurance claim processes and resolution. Recognized for exceptional problem-solving skills and ability to handle complex cases with accuracy. Effective team collaborator focused on achieving results and adapting to changing needs.
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Overview
9
9
years of professional experience
Work History
Claim Technician
Blue Cross Blue Shield of IL, MT, NM, OK & TX, Marion
Marion
07.2022 - Current
- Advised legal counsel on matters related to insurance contracts or dispute resolution proceedings.
- Conducted routine audits of existing claims files to ensure accuracy and completeness.
- Created comprehensive reports outlining the findings of investigations or assessments conducted on behalf of customers.
- Drafted letters informing claimants about their rights under applicable law or company policy.
- Maintained accurate records of claims data to ensure compliance with applicable regulations and company standards.
- Developed strategies to reduce costs associated with high-risk claims while maintaining excellent customer service levels.
- Communicated effectively with both internal staff members and external customers via phone, email, mail or other methods.
- Reviewed insurance policy to determine coverage.
- Calculated amount of claim.
Insurance Coordinator
Heartland Regional Medical Center, Marion
Marion
07.2020 - 07.2022
- Interview patients to determine how they can be assisted in receiving authorizations for their medication and procedures.
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
- Develop and implement prior authorization workflow, policies, and procedures.
- Collaborate with other departments to assist in obtaining pre-authorizations in a cross-functional manner.
- Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
- Review insurance policy to determine coverage.
- Prepare insurance claim forms or related documents and review them for completeness.
- Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
- Organize or work with detailed office or warehouse records, using computers to enter, access, search or retrieve data.
- Post or attach information to claim file.
- Pay small claims.
- Transmit claims for payment or further investigation.
- Contact insured or other involved persons to obtain missing information.
- Calculate amount of claim.
- Apply insurance rating systems.
Billing Supervisor
Midwest Medical Practice Management, Carbondale
Carbondale
05.2019 - 07.2020
- Answer customer questions regarding problems with their accounts.
- Locate and monitor overdue accounts, using computers and a variety of automated systems.
- Arrange for debt repayment or establish repayment schedules, based on customers' financial situations.
- Locate and notify customers of delinquent accounts by mail, telephone, or personal visits to solicit payment.
- Advise customers of necessary actions and strategies for debt repayment.
- Persuade customers to pay amounts due on credit accounts, damage claims, or nonpayable checks, or to return merchandise.
- Confer with customers by telephone or in person to determine reasons for overdue payments and to review the terms of sales, service, or credit contracts.
- Record information about financial status of customers and status of collection efforts.
- Sort and file correspondence, and perform miscellaneous clerical duties such as answering correspondence and writing reports.
- Perform various administrative functions for assigned accounts, such as recording address changes and purging the records of deceased customers.
Medical Billing Specialist
Midwest Medical Practice Management, Carbondale
Carbondale
08.2017 - 05.2019
- Receive payments and post amounts paid to customer accounts.
- Contact insurance companies to check on status of claims payments and write appeal letters for denial on claims.
- Trace delinquent customers to new addresses by inquiring at post offices, telephone companies, credit bureaus, or through the questioning of neighbors.
- Verify accuracy of billing data and revise any errors.
- Operate typing, adding, calculating, or billing machines.
- Prepare itemized statements, bills, or invoices and record amounts due for items purchased or services rendered.
- Review documents such as purchase orders, sales tickets, charge slips, or hospital records to compute fees or charges due.
- Perform bookkeeping work, including posting data or keeping other records concerning costs of goods or services or the shipment of goods.
- Keep records of invoices and support documents.
- Resolve discrepancies in accounting records.
- Type billing documents, shipping labels, credit memorandums, or credit forms, using typewriters or computers.
- Contact customers to obtain or relay account information.
- Compute credit terms, discounts, shipment charges, or rates for goods or services to complete billing documents.
- Answer mail or telephone inquiries regarding rates, routing, or procedures.
- Consult sources such as rate books, manuals, or insurance company representatives to determine specific charges or information such as rules, regulations, or government tax and tariff information.
Education
Medical Administrative Assistant -
John A Logan College
01-2012
Skills
- Team Player
- Positive Attitude
- Data Analysis
- Time Management
- Prioritizing
- Dependable
- Goal Setting
- Organizational Skills
- Claims Analysis
- Accountability
- Problem Solving
- Critical Thinking
- Decision Making
- Analytical Skills
- Time management
- Problem-solving abilities
- Multitasking
- Organizing and prioritizing work
- Multitasking Abilities
- Reliability
- Decision-making
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
Timeline
Claim Technician
Blue Cross Blue Shield of IL, MT, NM, OK & TX, Marion
07.2022 - Current
Insurance Coordinator
Heartland Regional Medical Center, Marion
07.2020 - 07.2022
Billing Supervisor
Midwest Medical Practice Management, Carbondale
05.2019 - 07.2020
Medical Billing Specialist
Midwest Medical Practice Management, Carbondale
08.2017 - 05.2019
Medical Administrative Assistant -
John A Logan College