Diamond Patton
Mesquite,TX
Summary
Dedicated Claims Processor with a proven track record in customer service and claims processing, seeking remote opportunities to review claim submissions, verify information, and adjudicate claims in strict adherence to claim processing guidelines. Recognized for delivering exceptional customer service while ensuring accurate and timely payment or denial in alignment with business requirements. Possesses strong analytical skills, attention to detail, and a commitment to maintaining the highest standards of quality and efficiency in claims management. Experienced in remote work environments and adept at collaborating with cross-functional teams to resolve complex claims issues and exceed performance targets. Ready to contribute expertise to a dynamic organization, optimizing claims processes and enhancing customer
Overview
7
7
years of professional experience
Work History
Medical Records Bookmarker
Maximus
02.2023 - Current
- Perform bookmaking tasks to create and maintain organized and up-to-date patient health records for veterans.
- Ensure the confidentiality and security of patient information in accordance with privacy regulations and VES standards.
- Conduct data entry with precision, maintaining accurate and easily accessible records for medical evaluations.
- Collaborate with healthcare providers and administrative staff to ensure the completeness and accuracy of patient records.
- Follow established procedures and contribute to the smooth operation of the medical records department, supporting the needs of veterans and VES.
Claims Processor
Blue Cross Blue Shield Of Texas
09.2019 - 01.2023
- Partnered with professional staff on pre-screening reviews, applying guidance and making appropriate decisions based on interpretation of provider information and department policies.
- Utilized analytical skills to interpret data and ensure accurate processing of claims within defined parameters.
- Collaborated with team members to identify work expectations and quality standards, prioritizing tasks effectively to meet deadlines.
- Followed standard policies and practices while exercising independent discretion as needed.
- Maintained a high level of accuracy and efficiency in claim processing, contributing to overall departmental goals and objectives.
Customer Service Advocate
OptumRx
04.2018 - 03.2020
- Resolve customer inquiries and complaints with an emphasis on service excellence, enhancing customer satisfaction and retention.
- Collaborate with healthcare providers and insurance companies to clarify claim details, contributing to the timely and accurate processing of claims.
- Maintain up-to-date knowledge of evolving policies and procedures to ensure compliance and efficiency in service delivery.
Technical Customer Care Associate
ADT Security Systems
08.2018 - 05.2019
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Followed up on emailed or web-submitted customer inquiries within standard response times.
- Responded to assistance requests from users and directed individuals through basic troubleshooting tasks.
- Explained technology-related details in easy-to-understand terms to individuals from different backgrounds and in various job positions.
Online Banking Specialist
Comerica Bank
05.2017 - 06.2018
- Ensured the timely and accurate posting of cash transactions, payments, adjustments, manual denials, insufficient fund checks/debit transactions, and general ledger accounting transactions.
- Reviewed, researched, and resolved payment variances to minimize inappropriate payment discrepancies from expected reimbursement.
- Processed payments, refunds, and adjustments in accordance with established procedures and guidelines.
- Collaborated with internal teams to investigate and resolve discrepancies, ensuring accurate financial records.
- Maintained organized documentation of payment transactions and related activities for auditing and reporting purposes.
- Utilized accounting software and systems to input and reconcile financial data, ensuring accuracy and completeness.
Education
High School Diploma -
Mesquite High School
Mesquite, TX05.2014
Skills
- Claims examination and adjudication
- Claim processing guidelines and regulations
- Analytical and problem-solving skills
- Attention to detail and accuracy
- Communication and collaboration
- Remote work proficiency
- Software proficiency (mention relevant tools if applicable)
Timeline
Medical Records Bookmarker
Maximus
02.2023 - Current
Claims Processor
Blue Cross Blue Shield Of Texas
09.2019 - 01.2023
Technical Customer Care Associate
ADT Security Systems
08.2018 - 05.2019
Customer Service Advocate
OptumRx
04.2018 - 03.2020
Online Banking Specialist
Comerica Bank
05.2017 - 06.2018
High School Diploma -
Mesquite High School
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