Deidra Gardner
Stockbridge,Georgia
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.
Overview
8
8
years of professional experience
Work History
Claims Analyst
Lumeris Healthcare
05.2022 - Current
- Investigate and processes moderately complex claims.
- Process 10 claims and hour.
- Follows precise instructions when processing claims.
- Completes assigned work and maintains production and quality standards.
- Extensively interacts cross-functionally to support resolution of claim issues.
- Researches and resolves adjustment inquiries.
- Performs edit resolutions from pended paper and electronic claims using critical decision-making skills for accurate claims processing.
- Works complicated reports, which involves critical decision making on adjustments, overrides of copayments, coinsurance, correct pricing and provider selection.
- Performs side by side comparisons to determine corrected claim actions.
- Issues letters & forms when appropriate.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Supported management''s decision-making process by providing insightful reports analyzing historical claims data.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Identified and resolved discrepancies between patient information and claims data.
- Coordinated with contracting department to resolve payer issues.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
CUSTOMER SERVICE TEAM LEAD
LUMERIS HEALTHCARE
01.2020 - 05.2022
- Handled complaints and resolved issues and concerns for members
- Assisted our Customer Service Representative with questions through chat and calls
- Provided coaching to 10 to 12 reps a week.
CUSTOMER SERVICE TEAM MEMBER
LUMERIS HEALTHCARE
01.2019 - 01.2020
- Researched and explained medical claims documents with members and providers
- Discussed benefits of Medicare Advantage Plans with new and existing members
- Assisted member with finding correct providers and coverage for their specific needs
- Educated members on billing procedures.
SERVICEABILITY
CHARTER COMMUNICATIONS
01.2018 - 01.2019
- Conducted building survey orders for Spectrum Services
- Guided techs on service calls to locate addresses and lines for members.
INSURANCE RISK INTERVIEWER
QUEST DIAGNOSTICS
01.2016 - 01.2018
- Managed underwriting application process for life insurance by organizing member's medical history.
- Conducted phone interviews to assess candidates based in remote locations.
Education
Medical Records - Medical Records
University of Phoenix
Tempe, AZ01.2023
Diploma in Medical and Health Care Administration -
CHASE COLLEGE
Los Angeles, CA01.2006
Skills
- Skilled in FACETS and SQL Production Reports
- Claims Processing
- Organizing and Prioritizing Work
- Thorough claims reviews
- Insurance Policies Knowledge
- Denied claims identification
- HIPAA Compliance Understanding
- Customer Service
Timeline
Claims Analyst
Lumeris Healthcare
05.2022 - Current
CUSTOMER SERVICE TEAM LEAD
LUMERIS HEALTHCARE
01.2020 - 05.2022
CUSTOMER SERVICE TEAM MEMBER
LUMERIS HEALTHCARE
01.2019 - 01.2020
SERVICEABILITY
CHARTER COMMUNICATIONS
01.2018 - 01.2019
INSURANCE RISK INTERVIEWER
QUEST DIAGNOSTICS
01.2016 - 01.2018
Medical Records - Medical Records
University of Phoenix
Diploma in Medical and Health Care Administration -
CHASE COLLEGE
Similar Profiles
Marshall SmithMarshall Smith
Principal Systems Administrator at Lumeris Healthcare Outcomes Inc, LumerisPrincipal Systems Administrator at Lumeris Healthcare Outcomes Inc, Lumeris
Gail Edson HaltermanGail Edson Halterman
Chief Legal Officer at LumerisChief Legal Officer at Lumeris
Rebecca HyattRebecca Hyatt
Customer Service Supervisor at Cognizant Technologies Solutions - Lumeris ProjectCustomer Service Supervisor at Cognizant Technologies Solutions - Lumeris Project
Nykolas CollinsNykolas Collins
Sr Project Engineer at CD Moody ConstructionSr Project Engineer at CD Moody Construction
Michael BrooksMichael Brooks
Retail Sales Associate at Academy Sports + OutdoorsRetail Sales Associate at Academy Sports + Outdoors