Gwendolyn Mehan
Medical Claims Processor
Colorado Springs,CO
Summary
Medical professional with extensive experience in processing medical claims, including claim review, adjudication, and resolution. Known for strong focus on collaboration and achieving results, adapting seamlessly to changing needs. Possesses key skills such as attention to detail, excellent communication, and problem-solving abilities.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Physician and Hospital Claims Processor
United Healthcare Medicare and Retirement
10.2017 - 08.2025
- Review and process Medicare/Medicaid claims according to plan guidelines within established turnaround time frames
- Interpret member plans to assure system is coded correctly
- Review claims for legitimacy and accuracy
- Meet production and quality standards set for examiners
- Other duties as assigned
Authorization and Referral Coordinator
United Healthcare Military and Veterans
10.2015 - 10.2017
- Daily processing of referral and authorization service requests within TRICARE contract time standards
- Makes benefit and coverage determinations based on TRICARE policy and UHCMV guidelines
- Processes Military Treatment Facility requests for identification and steerage for in network physician specialty referrals
- Sets up/documents/triages cases for Clinical Prior Authorization Review
- Verifies appropriate ICD-10 and CPT/HCPCS codes
- Resolves customer service inquiries which include: entering referrals/notifications, change provider status of an existing referral/notification, and determining if referral/notification is required
- Assists with faxes, emails, and letters to the beneficiaries, civilian providers, and the Military Treatment Facilities
- Make outbound calls as needed to providers to gather required information for referrals and authorizations
- Close attention to detail
- Consistently meets established productivity, schedule adherence, and quality standards
Military Service Representative
United Healthcare Military and Veterans
09.2013 - 10.2015
- Respond to complex customer calls
- Resolve customer service inquiries which could include:
- Benefit and Eligibility information
- Billing and Payment issues
- Customer material requests
- Physician assignments
- Authorization for treatment
- Explanation of Benefits (EOB)
- Provide excellent customer service
- Constantly meet established productivity, schedule adherence, and quality standards
Communications Equipment Operator
United States Air Force Reserve
03.2007 - 08.2013
- Perform daily unclassified network operations, including network management, control, security and administration
- Provide core network services designing, configuring, installing, and managing data services at network hardware and software operating system and server application level
- Perform system resource management, manage system user accounts, perform system wide backups/data recovery and load/capacity planning and management
- Implement and enforce national, Department of Defense, and Air Force security procedures and directives
- Process and review Combatant, Commander, Command, and Control (C4) systems requirement documentation, requests for service, telecommunications service requests, service orders, and status acquisition messages
- Manage organizational equipment accounts, verifying receipt, perform audits, and resolve reports discrepancies
Communications Equipment Operator
United States Air Force
12.2002 - 03.2007
- Ensured data integrity for a large space environment software project provided security, backup, and disaster recovery programs for 50+ member Technology Application Division
- Managed Primary Automated Data Processing Equipment, applying DoD (Department of Defense) policies and procedures in determining completeness of records and reports
- Procured computer equipment—researched equipment upgrades and certified purchases were cost efficient and fulfilled all mission requirements
- Customer service rapid response at all times-promptly restored corrupted files for executive staff while preserving vital data
- Member of 5-person team providing system configuration and administrative management for the Aerospace Environment Rapid Prototyping Center; baselined scientific tools in support of multiple DoD weapon systems
Education
Bachelor of Science - Business Administration
University of Colorado At Colorado Springs
Colorado Springs, CO 05.2001 -
Bachelor of Science - Computer Information Systems
University of Colorado At Colorado Springs
Colorado Springs, CO 05.2001 -
Skills
Unix
Microsoft Office suite including Access
SQL Plus
Oracle 9
Maximo
HIPAA compliance awareness
Claims processing proficiency
Medical Terminology Familiarity
Customer service
Continuous learning mindset
Thorough claims reviews
Telephone etiquette
Electronic claims processing
Teamwork
Data entry
Claims processing
Certification
Currently working on Medical Billing Certification
Timeline
Physician and Hospital Claims Processor
United Healthcare Medicare and Retirement
10.2017 - 08.2025
Authorization and Referral Coordinator
United Healthcare Military and Veterans
10.2015 - 10.2017
Military Service Representative
United Healthcare Military and Veterans
09.2013 - 10.2015
Communications Equipment Operator
United States Air Force Reserve
03.2007 - 08.2013
Communications Equipment Operator
United States Air Force
12.2002 - 03.2007
Bachelor of Science - Business Administration
University of Colorado At Colorado Springs
05.2001 -
Bachelor of Science - Computer Information Systems
University of Colorado At Colorado Springs
05.2001 -