Cynthia Cooper
Louisville,KY
Summary
Proven expertise in Medicare claims processing and coordination at Humana, Inc., achieving consistent quality and quantity metrics. Skilled in utilizing eHub and mentoring new staff, I excel in ensuring compliant and efficient claims resolution. Demonstrates strong analytical abilities and teamwork, enhancing payment integrity and operational excellence.
Overview
14
14
years of professional experience
Work History
Medicare Claims Pricer Specialist
Humana, Inc.
03.2020 - Current
- Maintained up-to-date knowledge of company's regulations, ensuring accurate and compliant claims processing.
- Coordinated with other departments such as Provider Payment Integrity and other areas to resolve any issues related to payment calculations to ensure correct payment of claims to providers.
- Contributed to departmental goals by consistently meeting or exceeding individual performance metrics for both quality and quantity of processed claims.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
UM Adminstration Coordinator
Humana, Inc.
09.2019 - 03.2020
- Conducts review and approvals or denial of Medicare member submitted pharmacy claims for reimbursement.
- Contacted pharmacies for verification of medication dosages for review for payment.
- Handled and completed daily assignments.
- Ability to work independently.
Medicare Claims Pricer Specialist
Humana, Inc.
10.2010 - 09.2019
- Maintained up-to-date knowledge of company's regulations, ensuring accurate and compliant claims processing.
- Coordinated with other departments such as Provider Payment Integrity and other areas to resolve any issues related to payment calculations to ensure correct payment of claims to providers.
- Contributed to departmental goals by consistently meeting or exceeding individual performance metrics for both quality and quantity of processed claims.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Education
No Degree - Computer Science
Sullivan University
Louisville, KY05.1994
Skills
- OneNote
- Cas
- Mentor
- eHub
- CisPro
- Zoom
- Teams
- CCP
- MARX
Timeline
Medicare Claims Pricer Specialist
Humana, Inc.
03.2020 - Current
UM Adminstration Coordinator
Humana, Inc.
09.2019 - 03.2020
Medicare Claims Pricer Specialist
Humana, Inc.
10.2010 - 09.2019
No Degree - Computer Science
Sullivan University
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