Summary
Overview
Work History
Skills
Timeline
Generic

HELENE HORNUNG

Overland Park,KS

Summary

Effective Medical Claims Processor with strong background in 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

13
13
years of professional experience

Work History

Clerical & Customer Service Support

Denver Tech Insurance
04.2018 - Current
  • Created quotes for group health and manages timeline for renewal activity, quoting, and enrollment per company and partner protocol
  • Coordinated with clients and insurance company personnel and facilitated client issues such as obtaining missing employee application information and employee waivers
  • Collected relevant employer forms and information and oversaw compliance with carrier procedures
  • Actively communicated with employers and carriers via email and phone to ensure applications process precisely.

Medical Claims Processor

RemX Staffing
11.2022 - 07.2023
  • Reviewed claims to ensure accuracy of CPT, ICD-10, and HCPCS coding for third-party administrator
  • Communicated with health insurance companies for verification of authorization code
  • Requested required information from both internal and external sources to establish if claim is complete and valid
  • Completed accurate analysis of claim determination for payment or denial based on established rules, processes, and group plan benefits
  • Inspected appropriate allocation of deductibles, co-pays, co-insurance, and reimbursements
  • Solved all issues related to claim adjudication and customer complaints and queries as received through customer service e-mail.

Community Living Instructor

Easterseals Midwest
01.2016 - 11.2017
  • Provided daily support to two individuals with developmental disabilities in achieving personal goals.
  • Accomplished administrative tasks, including financial budgeting, appointment scheduling, and administering medication.
  • Documented each client's progress with a respective treatment plan every week.
  • Utilized active listening skills when communicating with clients to better understand concerns and provided reassurance and support.
  • Maintained professional relationships with guardians and family members to enhance a supportive community culture.

Patient Account Coordinator

Lincare Holdings
06.2015 - 11.2015
  • Managed account balance issues and coordinated with internal department staff on obtaining current authorization codes, equipment transportation, and invalid patient information
  • Oversaw Medicaid billing and replacement plans for primary and secondary insurance in five states regarding supplies, medication transactions, and respiratory equipment
  • Verified existing insurance coverage by performing eligibility checks on Medicaid websites and updated system records with current insurance payer codes.
  • Responded to customer inquiries and provided detailed account information.
  • Entered client details and notes into the system for interdepartmental access and review.

Auditor

Wireless Lifestyle
06.2013 - 02.2014
  • Wireless Lifestyle
  • Successfully audited two hundred store wireless phone contracts daily for fraud detection and potential sales loss and completed online adjustments to retract sales commissions due to non-compliancy
  • Created audit reports to track daily store results and communicated with team members to effectively relay monthly store audit results
  • Coordinated with team to communicate monthly store audit results and reported to the Loss Prevention Manager regarding suspicion of fraudulent activity
  • Provided daily feedback to improve weekly sales records and wireless phone contracts.

Provider Bill Audit Analyst

Chartis Claims, Inc
08.2010 - 08.2012
  • Daily processed over 150 medical bills submitted using UB04 and CMS 1500 forms daily to reimburse medical services provided to worker’s compensation claimants
  • Utilized available medical records, system applications and web-based resources to validate billing charges in accordance with state regulations and fee schedules
  • Notified management of system-related issues affecting departmental processes and workflow
  • Paid, pended, or denied medical claims using established claims processing procedures as per state guidelines.

Skills

  • Medical Terms and Procedure Knowledge
  • Claim Validity Determination
  • Policy Requirements and Eligibility
  • Customer Service
  • Medical Terminology
  • ICD Codes
  • HIPAA
  • Great Mathematical Skills
  • Microsoft Office

Timeline

Medical Claims Processor

RemX Staffing
11.2022 - 07.2023

Clerical & Customer Service Support

Denver Tech Insurance
04.2018 - Current

Community Living Instructor

Easterseals Midwest
01.2016 - 11.2017

Patient Account Coordinator

Lincare Holdings
06.2015 - 11.2015

Auditor

Wireless Lifestyle
06.2013 - 02.2014

Provider Bill Audit Analyst

Chartis Claims, Inc
08.2010 - 08.2012

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HELENE HORNUNG