Autumn Rothfeldt
Fort Bragg,NC
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. 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. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
4
4
years of professional experience
Work History
Medical Claims Examiner
First Source
12.2023 - 05.2024
- Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
- Negotiated fair settlements with healthcare providers to minimize financial risk while ensuring adequate compensation for services rendered.
- Provided exceptional customer service, addressing concerns from policyholders and answering inquiries related to their claims status.
- Maintained compliance with industry regulations and company policies while evaluating medical claims for accuracy and legitimacy.
- Reduced errors in claim submissions by meticulously reviewing patient information and verifying insurance eligibility.
- Managed large volume of medical claims on daily basis.
- Monitored and updated claims status in claims processing system.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Examined claims forms and other records to determine insurance coverage.
Claims Processor
Florida Blue
08.2020 - 09.2022
- Monitored claims processing trends to identify potential areas of improvement.
- Evaluated accuracy and quality of data entered into agency management system.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Collected premiums and issued accurate receipts.
- Processed and recorded new policies and claims.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Modified, updated and processed existing policies.
- Calculated adjustments, premiums and refunds.
Member Service Representative
Florida Blue
08.2020 - 09.2022
- Learned internal systems and related service role duties to provide skilled team backup in handling customer demands.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions.
- Assisted members with correcting account, service, and system issues by educating on required forms and technical processes.
Claims Specialist
Florida Blue
08.2020 - 09.2022
- Medical billing/coding health insurance claims such as the Subscriber claim form, the institutional (UB-04) claim form, and the Professional (CMS-1500) claim form
- Entered health insurance data into the computer system (Data analysis)
- Processed, billed, adjusted, and adjudicated the health insurance claims., Worked and billed held claims with the current hold codes on the claims, looked up members benefits and other information to correct the claims, Assisted Florida Blue members with any questions and concerns about their health insurance plan.
- Utilized appropriate cost containment techniques to reduce overall claim costs.
- Conducted full claim investigations and reported updates and legal actions.
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
- Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Processed and recorded new policies and claims.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Collected premiums and issued accurate receipts.
- Modified, updated and processed existing policies.
Education
High school diploma -
Baker County High School
Skills
- Documentation abilities
- Prior authorization processing
- Insurance coverage verification
- Insurance industry experience
- Training and Development
- Data quality assurance processes
- ICD-10 proficiency
- Claims processing
- Customer service
- Insurance claims processing
- ICD codes
- Claims adjustment
Personal Information
Title:
Timeline
Medical Claims Examiner
First Source
12.2023 - 05.2024
Claims Processor
Florida Blue
08.2020 - 09.2022
Member Service Representative
Florida Blue
08.2020 - 09.2022
Claims Specialist
Florida Blue
08.2020 - 09.2022
High school diploma -
Baker County High School