CHE’REE MIDDLETON
Myrtle Beach,SC
Summary
Licensed Claims Adjuster with a comprehensive knowledge of claims adjusting. Enthusiastic to succeed in fast-paced, deadline-driven professional environment. indebt knowledge of medical claims processing and systems. Looking for a long-term position with a growth-oriented company.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Claims Representative (SIU)
CIGNA
Chattanooga, USA
04.2022 - Current
- Review claim submissions to confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.
- Follows established policies and procedures to pay, pend for additional information, or deny claims.
- Maintains a high level of accuracy in all duties performed.
- Claims adjusting, checking coding, and billed charges for accuracy.
- Documented changes in claim statuses using specialized software systems.
- Collaborated with other departments to resolve billing disputes or address customer concerns quickly.
Provider Reimbursement specialist
LOGISTICS HEALTH INC
La Crosse, USA
07.2021 - 04.2022
- Reviewed and processed reimbursement requests in accordance with company policies and procedures.
- Resolved discrepancies between provider documentation and insurance plan requirements.
- Analyzed patient data to ensure accuracy of reimbursement information.
- Investigated complex cases involving multiple providers or incorrect coding issues.
- Ensured compliance with applicable laws and regulations when processing reimbursement requests.
- Verified that all necessary documents were included in each request before submitting it for payment.
Certified Medical Assistant/prior Authorization Rep
LIBERTY DOCTORS
Pawleys Island, USA
03.2021 - 07.2021
- Obtained insurance authorizations for prescribed medications or treatments for patients in need of financial assistance programs.
- Provided support to physicians during consultations by recording patient histories accurately and documenting treatment plans accordingly.
- Assisted physicians and nurses with patient exams, including taking vital signs, preparing exam rooms, and updating medical records.
- Performed administrative duties such as scheduling appointments, answering phones, and filing paperwork.
- Provided support to patients by helping them fill out forms and answering their questions about health care services.
Certified Medical Assistant/Phlebotomist
OTHOSC
Murrells Inlet, USA
11.2018 - 04.2021
- Performed administrative duties such as scheduling appointments, answering phones, and filing paperwork.
- Provided support to patients by helping them fill out forms and answering their questions about health care services.
- Prepared specimens for laboratory testing and performed routine laboratory tests.
- Administered injections, immunizations, medications, wound dressings and other treatments according to physician instructions.
- Assisted in minor surgical procedures such as suturing lacerations or removing stitches under the direction of a physician.
Prior Authorization Rep/Referral Coordinator (HIV)
CARETEAM PLUS
Conway, USA
07.2019 - 02.2020
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Processed appeals in a timely manner as per policy guidelines.
- Maintained accurate records of all authorization activities in the database system.
Education
Medical Assisting
Horry-Georgetown Technical College
Conway, SC05-2018
Bachelor of Arts -
University At Albany (SUNY)
Albany, NY12-2010
Skills
- Conflict Resolution
- Policy investigations
- Settlement Negotiation
- Policy understanding
- Interpersonal Communication
- Settlement agreements
- Workers' compensation claims
- Medical Claims Processing
- Claims Ajudication
- Insurance fraud expertise
- Medical terminology specialist
Certification
- Certified Clinical Medical Assistant-National Health Care Association (NHA) 6/22/2016-Expired 2022
- South Carolina Personal Lines Adjuster License (SCDOI) 08/2024
Timeline
Claims Representative (SIU)
CIGNA
04.2022 - Current
Provider Reimbursement specialist
LOGISTICS HEALTH INC
07.2021 - 04.2022
Certified Medical Assistant/prior Authorization Rep
LIBERTY DOCTORS
03.2021 - 07.2021
Prior Authorization Rep/Referral Coordinator (HIV)
CARETEAM PLUS
07.2019 - 02.2020
Certified Medical Assistant/Phlebotomist
OTHOSC
11.2018 - 04.2021
Medical Assisting
Horry-Georgetown Technical College
Bachelor of Arts -
University At Albany (SUNY)
Similar Profiles
Diahanna BridgesDiahanna Bridges
Customer Service Representative at CignaCustomer Service Representative at Cigna
Rudee FriarRudee Friar
Customer Service Representative at CignaCustomer Service Representative at Cigna
Chasity CasonChasity Cason
Customer Service and Operations Analyst at CignaCustomer Service and Operations Analyst at Cigna
Tiffany LovatoTiffany Lovato
Customer Service Advocate at CignaCustomer Service Advocate at Cigna
Megan HigginsMegan Higgins
Clinical Placement Student Nurse Practitioner at Health and Wellness PsychiatryClinical Placement Student Nurse Practitioner at Health and Wellness Psychiatry