Cheryl Poderzay
Baxter,TN
Summary
ç Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
11
11
years of professional experience
Work History
Medical Claims Associate II
R1 Rcm
, CA
11.2022 - 07.2024
- Evaluated pending claims to identify and resolve problems.
- Documented file notes clearly and concisely in Epic.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Corresponded with insured or agent to obtain information or inform of account status or changes.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Accurately processed large volume of medical claims every shift.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Documented file notes clearly and concisely in Epic.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Collaborated with fellow team members to manage large volume of claims.
Medical Claims Associate II
Sutter Health
, CA
09.2013 - 11.2022
- Evaluated pending claims to identify and resolve problems. Checked documentation for appropriate coding, catching errors and making revisions.
- Verified insurance coverage of medical claims to ensure accurate reimbursement.
- Conducted detailed analysis of medical records to determine eligibility for services covered by insurance plans.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Sent clinical request and missing information letters to obtain incomplete information.
- Submitted appeals on behalf of providers when necessary due to denied or underpaid claims.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Accurately processed large volume of medical claims every shift.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Documented file notes clearly and concisely in Epic.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Collaborated with fellow team members to manage large volume of claims.
Education
Certificate - Health Administration
Western Career College
Citrus Heights, CA12.2007
High School Diploma -
Casa Roble Fundamental High School
Orangevale, CA06.1992
Skills
- Customer Service
- Friendly and Outgoing
- Phone and Email Etiquette
- Medical Terminology
- Insurance Billing
- HIPAA Compliance
- Multitasking and Organization
- Insurance Verification
- Insurance Company Knowledgeable
- Team Collaboration
- Eligibility Determination
- System Updating
Timeline
Medical Claims Associate II
R1 Rcm
11.2022 - 07.2024
Medical Claims Associate II
Sutter Health
09.2013 - 11.2022
Certificate - Health Administration
Western Career College
High School Diploma -
Casa Roble Fundamental High School
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