Crystal Rustman
Bakersfield,California
Summary
Adept Senior Claims Processor with a proven track record at Foundation for Medical Care, enhancing claims accuracy and compliance through expert ICD-10 coding and critical thinking. Spearheaded quality assurance initiatives, significantly improving data verification processes. Skilled in medical billing and mentoring, I excel in fast-paced environments, ensuring confidentiality and adherence to HIPAA standards.
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
18
18
years of professional experience
Work History
Senior Claims Processor/COB/Refund Coordinator
Foundation for Medical Care
12.2006 - Current
- Followed up with customers on unresolved issues.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Evaluated accuracy and quality of data entered into agency management system.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
- Managed workload and priorities to meet claims processing meet deadlines.
- Generated, posted and attached information to claim files.
- Coordinated with contracting department to resolve payer issues.
- Checked documentation for accuracy and validity on updated systems.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Calculated adjustments, premiums and refunds.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Education
Some College (No Degree) - Medical Billing And Coding
American Career College
Anaheim, CA02-2004
High School Diploma -
Paramount High School
Paramount, CA 06-1997
Skills
- ICD-10 coding
- CPT coding
- Training and mentoring
- Critical thinking
- Medical billing
- HIPAA compliance
- Claims review
- Payments posting
- Claims
- Data entry proficiency
- Medical terminology
- Problem-solving skills
Timeline
Senior Claims Processor/COB/Refund Coordinator
Foundation for Medical Care
12.2006 - Current
Some College (No Degree) - Medical Billing And Coding
American Career College
High School Diploma -
Paramount High School
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