Atiya Bealer Webb
The Colony
Summary
Results-driven Medicare Claims Specialist experienced in adjudicating complex Medicare claims within high-volume remote healthcare environments. Achieved recognition through consistent performance incentives for exceeding productivity goals and maintaining quality standards. Focused on resolving claims fairly while building productive relationships and effectively negotiating settlements.
Overview
12
12
years of professional experience
Work History
Healthcare Claims Specialist
Concentrix
01.2023 - Current
- Adjudicate Medicare claims while ensuring compliance with CMS regulations, payer policies, and internal quality standards.
- Successfully managed production volumes of up to 150 claims per day in high-volume environments while maintaining approximately 90% quality.
- Researched and investigated complex claims involving eligibility verification, authorizations, billing discrepancies, coding concerns, and benefit coverage to ensure accurate and timely resolutions.
- Review claim histories and documentation to resolve denials, appeals, and payment issues.
- Performed documentation reviews supporting payment integrity and regulatory compliance.
- Collaborated with cross-functional teams to effectively resolve escalated claims, enhancing overall claim processing efficiency.
- Utilize HRP, MedCompass, Copilot, Rumba, ECHS, NIPPES, and Burgess daily.
- Consistently recognized with monthly performance incentives for exceeding production goals.
- Managed client relations for Aetna, ensuring effective communication and service delivery.
Bookeeping
Financial Telesis Network
San Diego
01.2015 - Current
- Completed day-to-day duties accurately and efficiently.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Optical Technician
James Eye Care & Optics Gallery
Little Rock
06.2019 - 07.2020
- Fabricated and adjusted optical lenses for various prescriptions.
- Calibrated optical instruments to guarantee precise measurements.
- Collaborated with optometrists to ensure accurate lens specifications.
- Conducted thorough inspections of eyewear for quality assurance.
- Assisted customers with frame selection and fitting consultations.
- Educated patients on contact lens care, insertion, removal, and hygiene practices.
- Educated customers on proper eyewear care and maintenance techniques.
- Resolved customer complaints regarding product quality or service issues promptly.
- Procured stock from suppliers to ensure customer orders were met.
- Maintained inventory records of raw materials and finished products.
- Maintained clean, organized and well-stocked examination rooms by resetting spaces between appointments.
- Performed routine maintenance and calibration of optical instruments.
- Obtained accurate patient histories through detailed interviews and documented information in EHR.
- Sent patient prescriptions to pharmacies and scheduled future appointments.
- Completed administrative tasks related to record keeping and documentation.
Education
Graduate -
Del Norte High School
Skills
- Medicare Claims Adjudication
- Claims Investigation
- Claims management
- Appeals & Denials
- Payment Integrity
- Documentation Review
- Revenue Cycle
- Compliance
- Regulatory compliance
- CMS Regulations
- Policy Interpretation
- Data Management
- Quality control
- Trend analysis
- Problem solving
- Performance optimization
- Attention to detail
- Time management
- Team collaboration
- Customer service
- Trend analysis
Open To Remote
True
Professional Highlights
True
Timeline
Healthcare Claims Specialist
Concentrix
01.2023 - Current
Optical Technician
James Eye Care & Optics Gallery
06.2019 - 07.2020
Bookeeping
Financial Telesis Network
01.2015 - Current
Graduate -
Del Norte High School