Crystal A. Mitchell
Summary
Professional with comprehensive background in processing, prepared to bring high standards to new role. Known for improving operational efficiency and ensuring accuracy in documentation. Team-oriented with strong focus on achieving results and adapting to changing needs. Proficient in data management and regulatory compliance.
Overview
19
19
years of professional experience
Work History
Advanced Claim Processor
Dentaquest/SunLife
01.2022 - Current
- Responsible for processing Government and Mass Health PDM (provider data management) dental claims by verifying, adding, and/or updating the dental provider in the Windward system
- Responsible for creating and saving PDF files for all verified providers in the S: drive
- Assists Government claims department when needed
- Responsible for logging and distributing checks for multiple business units when needed
- Responsible for processing and/or forwarding SunLife check inquiries when needed
- Assists the Claim Retention and Recovery team with noting claims for any void and reissue requests
- Provides feedback for learning opportunities
- Consistently process claims with 99% accuracy
Claim Processor
Dentaquest
10.2019 - 12.2021
- Processed Government dental claims from various work queues including but not limited to, Advanced Claims Resolution Specialist-Manual Pricing, Advanced Claims Resolution Specialist, Claims Resolution Specialist, and Member Pays
- Created and submitted Texas Subrogation letters for mailing when needed
- Pulled and distributed TAT (Turn Around Time) assignments to the claims team when needed
- Provided feedback for learning opportunities
- Consistently processed claims with 99% accuracy
Employer Install Representative
United Healthcare
11.2018 - 10.2019
- Implemented, reviewed, researched, investigated, processed, and adjusted employer's COBRA/State Continuation rates/premiums
- Provided employers, employees and/or brokers additional COBRA documentation when needed
- Responded to employers, employees, and/or brokers' concerns via phone or email
- Provided feedback for learning opportunities
Claims Representative
United Healthcare
12.2015 - 11.2018
- Reviewed, researched, investigated, processed and adjusted reimbursement claims
- Authorized appropriate payment or referred claims to investigators for further review
- Data entry and re-work via computer
- Analyzed and identified trends and produced reports when necessary
- Selected to audit and provide feedback for claims processed by onboarding offshore employees
Appointment Services Representative
Medical College of WI
12.2014 - 12.2015
- Scheduled, canceled, and rescheduled appointments via phone for multiple specialties and locations including providing directions, instructions, and other information regarding appointments
- Entered full registration including setting up insurance coverage for new patients and verified registration and coverage information for established patients
- Reviewed MSP questionnaires with Medicare patients
- Worked through referral queues, messages, faxes, emails, and other correspondence following detailed guidelines to schedule patient appointments and communicate back to referring physicians if unable to schedule
- Checked emails and EPIC In Basket regularly to stay current with any changes and receive information on patients in need of an appointment
- Ensured a positive customer experience by anticipating and diffusing customer challenges
- Assisted with quality control measures and special projects including rework quality review of self and colleagues, verified protocol and report accuracy
- Entered referral authorization information into Cadence Referral module
Patient Access Service Representative
Sargeant Internal Medicine
04.2011 - 12.2014
- Obtained and/or verified/updated registration information and routes patient and paperwork appropriately
- Assisted MyChart enrollment
- Received and reconciled co-pays and account payments
- Scheduled patient appointments
- Answered incoming phone calls
- Would route calls and staff messages to appropriate areas
- Answered non-medical questions and relayed non-medical information to patients within clinic and HIPAA guidelines
- Ordered office supplies
- Assisted with new employee onboarding
Customer Service Representative
Adecco/GE Healthcare
12.2009 - 03.2011
- Answered service calls in the cardiovascular call center
- Entered the customer's service request into the database
- Dispatched engineers for service calls
- Transferred calls to online engineers
- Answered service calls in the CARES call center
Provider Data Unit Senior
Assurant Health
11.2005 - 11.2009
- Prepared spreadsheets for morning reports
- Managed and maintained office documentation
- Served as a liaison between the unit and upper management
- Processed claims, when needed
- Assisted on projects that would improve the unit's workflow
- Maintained the office in the supervisor's absence
- Assisted with new employee onboarding
- Assisted supervisor with special projects
Education
Associate in Science - Medical Assisting
Bryant & Stratton College
Milwaukee, WI04.1999
Skills
- Data Management
- Information management
- Document preparation
- Data processing
Timeline
Advanced Claim Processor
Dentaquest/SunLife
01.2022 - Current
Claim Processor
Dentaquest
10.2019 - 12.2021
Employer Install Representative
United Healthcare
11.2018 - 10.2019
Claims Representative
United Healthcare
12.2015 - 11.2018
Appointment Services Representative
Medical College of WI
12.2014 - 12.2015
Patient Access Service Representative
Sargeant Internal Medicine
04.2011 - 12.2014
Customer Service Representative
Adecco/GE Healthcare
12.2009 - 03.2011
Provider Data Unit Senior
Assurant Health
11.2005 - 11.2009
Associate in Science - Medical Assisting
Bryant & Stratton College
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