Summary
Overview
Work History
Education
Timeline
Generic

Charmese Keyser

Philadelphia,Pa

Summary

To effectively utilize my customer service skills, knowledge and experience of the healthcare industry in a challenging and productive environment offering advancement and opportunity for growth. Profile: Over 15 years industry experience in multiple areas of healthcare including claims, utilization management, provider contracting, compliance, EDI, workers compensation, Facets, Third party billing and pre-certification. Extensive marketing background. Received top awards for outstanding presentations. Advanced Microsoft Office 2021, Excel, Word, Access, PowerPoint. knowledge of medical terminology, ICD-10 codes and 10-key skills. Possess excellent analytical, interpersonal, communications skills and experience with medical records.

Overview

24
24
years of professional experience

Work History

Home health aide

Americas Home health
Philadelphia, PA
02.2023 - Current
  • Provide direct care, personal assistance and support to patients that are ill, elderly and or disabled
  • Prepare client meals and snacks
  • Administer medications and accompany patients to doctor appointments as needed.

Claims examiner

AmeriHealth Caritas
Philadelphia, PA
02.2013 - 01.2023
  • Reviewed and adjudicated health related claims based on policy provisions and established guidelines
  • Initiated and completed claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits

Title Clerk

Insurance Auto Auction
Conshohocken, PA
01.2011 - 02.2013
  • Processed and re-assigned titles for vehicles sold by the auction
  • Examined vehicle title for accuracy and conformity to specified requirements
  • Verified acceptance of the title in the state for which it was filed
  • Confirmed accurate title VIN number and odometer reading
  • Maintained knowledge of current DMV laws and regulations for each state for which vehicles were processed.

Office Team Precert Specialist

Bravo Health
Philadelphia, PA
01.2010 - 05.2010
  • Responsible for explaining benefits, the billing process and financial responsibilities to patients
  • Obtained complete and accurate insurance information and benefit verification
  • Notified members and providers of all clinical determinations.

Office Team Provider Claims Advisor

MedRisk, Inc
Philadelphia, PA
05.2008 - 10.2009
  • Provided excellent customer service for a third party billing company
  • Review of Workers Compensation medical bills
  • Maintained heavy telephone contact with providers to ensure accurate processing of bills through emails, faxes and special projects
  • Determination of the accurateness and appropriateness for the diagnosis and /or requested additional documentation to approve or deny the bill.

Customer service manager

Swift Plumbing
Chester, PA
11.2004 - 01.2007
  • Strategically used territory records and promotional material to increase the flow of business
  • Created Presentations and newsletters for potential customers
  • Managed relationships with clients and handled all finances.

Senior claims examiner

Independence Blue Cross
Philadelphia, PA
05.2000 - 10.2004
  • Processed Generic, Managed Care, OPL, automobile, workers compensation, ancillaries, Medicare, Medicaid and specialty claims
  • Expediting telephone inquiries to members and providers for claim adjudication
  • Achievements: Consistently exceeded quarterly quota by 90%

Education

Medical and Dental Assistants Certified Medical Assistant -

Community College of Philadelphia, Delaware Valley Academy
01.2009

01.1999

Timeline

Home health aide

Americas Home health
02.2023 - Current

Claims examiner

AmeriHealth Caritas
02.2013 - 01.2023

Title Clerk

Insurance Auto Auction
01.2011 - 02.2013

Office Team Precert Specialist

Bravo Health
01.2010 - 05.2010

Office Team Provider Claims Advisor

MedRisk, Inc
05.2008 - 10.2009

Customer service manager

Swift Plumbing
11.2004 - 01.2007

Senior claims examiner

Independence Blue Cross
05.2000 - 10.2004

Medical and Dental Assistants Certified Medical Assistant -

Community College of Philadelphia, Delaware Valley Academy

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Charmese Keyser