CHRISTOPHER GORDON

Analyze and process insurance claims in accordance with policy terms and conditions
Review medical records, reports and billing statements for accuracy
Consult with medical providers to clarify diagnosis or to obtain additional information
Determine the payment amount based on the claim, policy details, and other relevant factors
Communicate with policyholders and providers about the status of claims, payment decisions, and any issues that may arise
Identify and report any suspicious, fraudulent, or anomalous claims
Keep up to date with new medical terminologies, procedures, and regulations that affect health insurance policies
Maintain accurate records and prepare reports on claim activity
Provide customer service to policyholders, addressing their queries and concerns regarding policies and claims
Conduct audits to ensure compliance with state and federal regulations
Enforced a targeted collections strategy for outstanding medical bills, payor submissions, corrected and verified insurance was submitted to correct claims department increasing recoveries by 50% within a year.
Partnered with insurance companies and healthcare providers to reconcile claims discrepancies, recovering unpaid balances totaling

• Contacted insurance companies to discuss and resolve unpaid claims and incorrectly paid claims.
• Managed large client portfolios effectively while maintaining strong relationships with policyholders through clear communication channels.
• Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
• Performed needs analysis to obtain information required to make appropriate health insurance product recommendations.
• Answered inbound calls from existing and future policyholders to answer inquiries and discuss insurance options.
• Ensured compliance with state regulations regarding health insurance policies, diligently monitoring updates to laws and guidelines.
• Optimized workflow processes within the team, resulting in improved overall productivity and reduced backlogs in claims processing.
• Maintained up-to-date knowledge on industry developments, attending workshops and professional conferences regularly.

• Reviews and adjudicates routine claims in accordance with claim processing guidelines
• Analyzes and approves routine claims that cannot be auto adjudicated
• Applies medical necessity guidelines, determines coverage, complete eligibly verification, identify discrepancies and applies all cost containment measures to assist in the claim adjudication process
• Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues
• Routes and triages complex claims to Senior Claim Benefits Specialist
• Proofs claim or referral submission to determine, review or apply appropriate guidelines, coding, member identification process, diagnosis and pre-coding requirements
• May facilitate training when considered topic subject matter expert
• In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters
• Utilizes all applicable system functions available ensuring accurate and timely claim processing services
• Managed a caseload of complex claims, ensuring timely settlements and maintaining client satisfaction.
• Evaluated potential exposure levels associated with high-value complex claims to ensure adequate reserves were established in accordance with established guidelines and industry best practices.
• Improved department efficiency with the development of comprehensive performance metrics to track individual progress and adjust workload distribution accordingly.

• Create daily work instructions and task
• Conduct quarterly training on company work procedures and policies
• Validate New Equipment to be utilized for production
• Clean, prepare, and assemble product
• Operate the therma 650,450 and Gut 650 Colimatic equipment used for production
• Conduct one on one coaching sessions with operators to ensure daily goals are met
• Conduct quality line checks and inspection of outgoing product
• Ensure quality of final product
• Maintain equipment in clean and orderly condition
• Report defective material or questionable condition to the department supervisor
• Contribute and adhere to safety and quality
• Communicate status of operation in a timely manner to management including any safety and/or process problems
• Lead over 8-10 employees in a clean room setting

• Ability to setup, operate, monitor and adjust production related equipment to assure safe equipment operation and product quality
• Be knowledgeable of and follow all Environmental, Health, and Safety practices
• Execution of daily activities ensuring production deadlines are met in a safe and timely manner
• Participate in job related training
• Ability of being crossed trained in other work-related areas and processes
• Follow SOP as required by job assignments
• Assist in equipment inspections and calibration
• Identification if equipment malfunctions and maintenance notifications
• Housekeeping and 5S sustainability
• Control product quality through communicating item damage or off spec condition that exist to QC
• Other duties as assigned by supervisors

• Company Overview: Lead sterile processing technician for a Level 1 multi-facility health system in North Alabama
• Daily duties include thorough handling of medical instrumentation for all surgical specialties, quality control, care and handling and sterile preparation of medical equipment and surgical instrument sets
• Assembles instruments sets and wrap instruments to be processed in instrument area with minimal errors
• Expert knowledge of decontamination procedures
• Conducts biological tests on sterilization and decontamination equipment
• Acts as a trainer for newly hired staff
• Prepares case carts for surgical procedures from physicians' preference cards
• Acquires supplies and sterile instruments for surgical procedures
• Extensive knowledge of universal precautions, infection control and safety
• Extensive knowledge of quality control and handling of all surgical specialties
• Operational knowledge of the AAMI standards of steam, Steris, Sterrad and Ethylene Oxide sterilization methods
• Maintaining daily records on sterilizing procedures
• Expert knowledge of SPM / ATTEST tray tracking and monitoring systems
• Proficiency with Windows, Microsoft Office and various proprietary inventory software suites
• Lead sterile processing technician for a Level 1 multi-facility health system in North Alabama