Dorothy Cohen
Levittown,NY
Summary
Results-driven Medical Claims Representative with a proven track record in high productivity and efficient task completion. Specializes in claims processing, policy interpretation, and dispute resolution, ensuring accuracy and compliance with industry standards. Strong communication, problem-solving, and negotiation skills contribute to streamlined operations and enhanced customer satisfaction.
Overview
25
25
years of professional experience
Work History
Medical Claims Representative
NYU Langone
Mineola, New York
04.2013 - Current
- Process payments from various insurance companies according to their guidelines.
- Advise patients regarding billing issues, payment options, and reimbursement procedures.
- Review patient records to verify insurance coverage and eligibility for services.
- Compile and submit claims forms, medical reports, and other supporting documents to insurance companies.
- Investigate and resolve denied or rejected claims quickly and accurately.
- Identify areas where operational improvements could be made in order to streamline processes.
- Participate in educational seminars and webinars related to industry best practices.
- Communicate with insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Review documentation for appropriate coding and errors, making revisions as needed.
- Correspond with both the insured and/or the agent to obtain information and inform appropriate parties of account status changes.
Claims Representative
Northwell Hospital
Manhasset, New York
01.2001 - 03.2013
- Assisted in developing new processes and procedures for improved efficiency.
- Collaborated with other departments to resolve billing disputes or address customer concerns quickly.
- Analyzed trends in claim denials or delays to identify areas for improvement within the organization.
- Attended continuing education seminars related to insurance industry best practices and new legislation.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
Education
Medical Terminology
Nassau Community College
Garden City, NYSkills
- Claims Processing
- Medical Coding
- Insurance Verification
- Healthcare Regulations
- Payment Reconciliation
- Proficient in Epic, Soarian, Craneware
- Fluent in Microsoft Office (Word, Excel, PowerPoint)
- Attention to Detail
- Time Management
- Effective Communication
- Team Collaboration
- Problem Resolution
Languages
English
Full Professional
Polish
Native/ Bilingual
Timeline
Medical Claims Representative
NYU Langone
04.2013 - Current
Claims Representative
Northwell Hospital
01.2001 - 03.2013
Medical Terminology
Nassau Community College
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