Cimaiya Jones
Norcross,GA
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
13
13
years of professional experience
Work History
Medical Claims Specialist
Conduent
07.2021 - Current
- Submitted electronic/paper claims documentation for timely filing.
- Monitored and updated claims status in claims processing system.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Medical Biller, Accounts Receivable
Atlanta Rehabilitation & Performance Center
11.2020 - 07.2021
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Posted payments and collections on regular basis.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
Resident Care Aide
Phoenix Of Lake Lanier
12.2019 - 12.2020
- Interacted kindly with patients and families and displayed positive, outgoing attitude, resulting in establishment of long-term, professional relationships.
- Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
- Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
- Helped patients safely transition between sleeping surfaces and mobility assistance such as wheelchairs by providing consistent support.
- Recognized and reported abnormalities or changes in patients' health status to case manager.
Office Coordinator
The Joint Chiropractic
10.2018 - 11.2020
- Interacted with customers by phone, email, or in-person to provide information.
- Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
- Maintained office supplies inventory by checking stock and ordering new supplies.
- Worked collaboratively with office staff to maintain smooth operations and team readiness for unexpected demands.
- Supported billing staff by making corrections to invoices and insurance submissions.
- Addressed complaints made by patients and staff by escalating issues to supervision for further investigation.
Intake Specialist
Change Healthcare
10.2018 - 10.2020
- Answered phone calls and provided new clients with required paperwork to initiate service.
- Completed intake assessment forms and filed clients' charts.
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
- Assessed clients' needs and determined eligibility for intake services.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Managed workload and priorities to meet claims processing meet deadlines.
Registration Coordinator
Beneva Lakes Health And Rehab
01.2015 - 11.2018
- Led pre-application outreach programs, targeting potential students based on institutional priorities and goals.
- Audited degree candidate lists to maintain adherence to institution guidelines on enrollment levels.
- Monitored students' ongoing records, directing issues with missing grades, curricular discrepancies and other variances to appropriate faculty.
- Directed student and faculty feedback operations, promptly remedying [Type] issues.
- Communicated with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures.
- Maintained confidentiality of patient data and condition to safeguard health information.
Medication Technician
Beneva Lakes Assisted Living
01.2013 - 06.2018
- Prepared medication doses accurately by following medication administration record (MAR) written by healthcare providers.
- Reordered medication to maintain adequate supply.
- Documented medication administration into electronic medical records (EMR) to avoid duplication of medication dosages.
- Counted and recorded medication inventory routinely to maintain medication security and control.
Benefits Verification Specialist
Beneva Lakes Health And Rehab
01.2011 - 05.2015
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Checked employees' benefits enrollment for accuracy and inputted all data into [Software].
- Implemented open enrollment system to streamline benefits processes for employees.
- Analyzed and reported on employee benefits data to identify trends and develop strategies for improvement.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
Education
Bachelor of Arts - Psychology
South University
Savannah, GA12.2024
Tech School - Medical Administrative Assistant
Earl C. Clements Job Corp
Morganfield, KY11.2012
High School Diploma -
Riverview High School
Sarasota, FL06.2011
Skills
- Microsoft Project
- Critical Thinking
- Customer Service
- Data Analysis
- Claim Validity Determination
- Customer Satisfaction
- Benefits Guidelines
- Data Security Procedures
- Thorough Claims Reviews
- ICD-10 Coding
- Health Insurance Industry Knowledge
- Patient Admission
- Medical Terminology
- Insurance Policy Coverage Knowledge
- Electronic Claims Processing
- Insurance Claims Management
- Electronic Health Records
- Medical Terms and Procedure Knowledge
- Outpatient Procedures
- Insurance Claims
- Insurance Plan Verification
- Microsoft Office
- HIPAA Procedures
- ICD Codes
- Accuracy Verification
- Health Management Information Systems
- Medical Records and Documentation
- Billing Software
- Accounts Payable and Accounts Receivable
- Microsoft Access
- Knowledge of HIPAA Regulations
- Claims Preparation
Timeline
Medical Claims Specialist
Conduent
07.2021 - Current
Medical Biller, Accounts Receivable
Atlanta Rehabilitation & Performance Center
11.2020 - 07.2021
Resident Care Aide
Phoenix Of Lake Lanier
12.2019 - 12.2020
Office Coordinator
The Joint Chiropractic
10.2018 - 11.2020
Intake Specialist
Change Healthcare
10.2018 - 10.2020
Registration Coordinator
Beneva Lakes Health And Rehab
01.2015 - 11.2018
Medication Technician
Beneva Lakes Assisted Living
01.2013 - 06.2018
Benefits Verification Specialist
Beneva Lakes Health And Rehab
01.2011 - 05.2015
Bachelor of Arts - Psychology
South University
Tech School - Medical Administrative Assistant
Earl C. Clements Job Corp
High School Diploma -
Riverview High School
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