Brianna Jones
FORT LAUDERDALE,Florida
Summary
To obtain a long term position with an established company that offers non-stop learning and career growth.
Overview
5
5
years of professional experience
Work History
Claim Specialist
American Customer Care
2023.04 - Current
- Handled billing related activities focused on medical specialties.
- Retained strong medical terminology - examples: Insurance plan sponsor names, converting and data entering procedure and diagnosis codes (ICD10 - ICD9), determining inpatient - outpatient - specialist - PCP services.
- Processed claims for payment or forwarded to appropriate personnel for further investigation.
- Checked documentation for appropriate coding, catching errors and making revisions - data entry skills.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Organized information by using spreadsheets, databases or word processing applications. Examples of systems include: Excel, OneNote, TEAMS, Outlook email.
- Examined claims, records and procedures to grant approval of coverage.
- Followed all HIPPA protocol's to ensure private member information remained secure.
- Converted and data entered paper claims to electronic data bases.
- Contacted medical providers for any missing or incorrect information.
Claim Specialists
Continuous Care Center
2020.12 - 2023.04
- Intake and create cases in all applicable systems.
- Determine and understand the coverage provided under a member's health plan
- Efficiently use multiple systems and screens to obtain and record claim information
- Review claims information to determine the nature of a member's illness or injury
- Identify claim cost management opportunities and refer claims for follow up
- Make claim payment decisions
- Process claims accurately to enhance customer satisfaction and retention
- Process claims within quality and production standards
- Ensure compliance with HIPAA regulations and requirements.
- Other Duties as assigned.
Insurance Verification /Payment Poster
T2 Flex Force
2019.02 - 2020.12
- Responsible for verifying patient insurance coverage, to ensure that services are covered by the individual’s provider.
- Entering data in an accurate manner, updating patient benefit information in the organization’s insurance system.
- Ensures all incoming payments, allowance, adjustments, denial/rejections, etc. are posted correctly and in a timely manner.
- Verifying existing patient benefits, to make sure benefits are up to date and information is accurate.
- Apply insurance payments according to specific dates and procedures according to the EOB.
- Responsible for posting payments, adjustments and rejections to patient accounts.
- Responsible for posting of all insurance payments via ERA, hard copies, payer websites, and Salesforce Portal.
- Close batches in system at the end of the day and meet monthly or quarterly goals set by Management.
Education
High School Diploma -
Boyd H. Anderson High School
Lauderdale Lakes, FLSkills
- Written/Verbal Communication
- Detail Oriented
- Teamwork Abilities
- Problem-solving
- Analytical and Critical Thinking
- Medical Terminology
- Multitasking Abilities
- Healthcare Insurance Knowledge
Timeline
Claim Specialist
American Customer Care
2023.04 - Current
Claim Specialists
Continuous Care Center
2020.12 - 2023.04
Insurance Verification /Payment Poster
T2 Flex Force
2019.02 - 2020.12
High School Diploma -
Boyd H. Anderson High School
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