FELICIA TUCKER
Claims examiner
2635 Contra Costa Blvd Apt A2 Pleasant Hill ,CA
Summary
Dynamic Claims Examiner with 2.5 years of extensive experience, adept at resolving complex claims issues and streamlining workflows. Proficient in Allscripts EHR and data entry, demonstrating strong problem-solving abilities. Proven track record in managing high call volumes while delivering exceptional customer service and ensuring compliance with Medicare guidelines. With 9 years of experience in medical filed. Diligent Claims Examiner with solid background in processing and evaluating insurance claims. Effectively managed numerous cases, ensuring accurate and timely resolution. Demonstrated strong analytical skills and attention to detail in complex claim assessments.
Overview
15
15
years of professional experience
Work History
Claims Examiner
Center For Elders Independence
09.2022 - Current
- Process professional claims, Hospital claims, Dental claims, Dialysis claims, Skilled nursing claims, Ambulance claims, flowering Medicare / Medi-cal guidelines
- Answer high call volume and provide claim status solve problems with payment provide EOB provide check tracer Answer general billing questions.
- Check voicemail daily call back the same day.
- Pickup mail sort the mail, scan, long documents in the appropriate spreadsheets. Sent out Appeal acknowledgment letters, timely manner so that it in compliance.
- Send out refund letter's process and apply refund to claim's process partial refunds, bulk refunds, full refunds.
- Work on outstanding checks call vendors / providers and get updated address provide stop payments to solve missing payment's.
- Call vendors/ providers and obtain W-9 to keep addresses updated and set up new providers.
- Managed large volume of medical claims on daily basis.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Streamlined workflow for faster resolution of medical claims through effective prioritization and organization.
Receptionist
Center For Elders Independence
05.2018 - 09.2022
- Welcomed office visitors warmly and alerted staff to arrivals of scheduled appointments
- Answered incoming calls on high-volume transferred callers to appropriate personnel
- Take pictures and create badges for new hires, create replacement badges
- Create file number for new hires
- Sort checks stabs for payroll to have check stabs ready for pickup
- Give out parking validations to visitors
- Prepared packages for Fed Ex deliveries and coordinated timely shipments
- Sorted incoming mail and directed to correct personnel each day
- Gathered, sorted, distributed and sent mail and packages
- Kept reception area clean and organized to offer positive first impression to every visitor
- Greeted customers, answered general questions and directed to appropriate locations
- Provided administrative support to team members, including making copies, sending faxes, organizing documents and rearranging schedules
- Answered calls to help over 100 customers
- Assisted 5 visitors with in three minutes by directing to appropriate personnel and answering average of 50 calls and emails daily
Medical Receptionist
Pediatric Evening Referral Clinic
12.2015 - 12.2017
- Greet persons entering establishment, determine purpose of visit
- Checking in patients, take co-pays
- Fax over patients reports to primary care doctor
- Reviewed charts and flagged incomplete or inaccurate information
- Prepared and sent financial statements to support bookkeeping functions
- Delivered high-quality administrative and customer service to sustain patient and work flows
- Straightened up waiting room so that it remained neat and organized
- Compiled physical and digital paperwork to meet business and patient needs, including charts, reports and correspondence
- Organized paperwork such as charts and reports for office and patient needs
- Processed patient payments and scanned identification and insurance cards
- Interviewed patients to collect medical information and insurance details
- Supported administrative and healthcare staff with skilled clerical assistance such as ordering supplies and organizing office inventories
Medical Assistant
Parkside Family Medical Group
01.2013 - 11.2015
- Collected and documented patient medical information such as blood pressure and weight
- Collect blood, tissue, or other laboratory specimens
- Perform routine laboratory tests and urine dipstick
- Perform Venipunctures order lab requisition
- Administer injections, immunization on adults, newborns, children
- Set up pelvic exam trays for pap smear and STD'S screening
- Performed front desk duties, including answering phones, scheduling appointments, greeting patients and ordering supplies
- Assessed, documented and monitored vital signs for more than 30 patients per day
- Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs.
- Followed all appropriate procedures to minimize patient's exposure to radiation.
Zone Leader
Forever 21
03.2010 - 01.2013
- Opened and closed store independently and prepared nightly bank drop for manager.
- Maintained clean sales floor and straightened and faced merchandise.
- Greeted customers and helped with product questions, selections and purchases.
- In charge of sorting merchandise for the go backs.
- Trained new associates on keeping the floor clean and increasing sales.
- Stocked merchandise, clearly labeling items and arranging according to size or color.
- Volunteered for extra shifts during holidays and other busy periods to alleviate staffing shortages.
- Trained new associates on cash register operations, conducting customer transactions and balancing drawer.
Education
Medical Assisting -
Everest College
San Francisco, CA2009
Skills
- Experience with Allscripts EHR
- Expertise in EZ-CAP Software
- Microsoft Outlook Proficiency
- Excel Proficiency
- Accurate Data Entry
- Inventory Oversight
- Claims Review
- HCPCS Coding Proficiency
- Claims Processing
- Analytical Problem-Solving
- Experienced in Microsoft Word Applications
Timeline
Claims Examiner
Center For Elders Independence
09.2022 - Current
Receptionist
Center For Elders Independence
05.2018 - 09.2022
Medical Receptionist
Pediatric Evening Referral Clinic
12.2015 - 12.2017
Medical Assistant
Parkside Family Medical Group
01.2013 - 11.2015
Zone Leader
Forever 21
03.2010 - 01.2013
Medical Assisting -
Everest College
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