Huong Dao
Houston,TX
Summary
Claims specialist with results-driven mindset and focus on efficient claims processing and resolution. Skilled in analyzing complex claims, verifying coverage, and negotiating settlements, with strong emphasis on team collaboration and adapting to changing needs. Known for reliability, attention to detail, and delivering consistent outcomes in high-pressure environments.
Overview
14
14
years of professional experience
Work History
Claims Benefits Specialist
Texas Children's Health Plan
11.2021 - Current
- Processed Health Plan Appeals according to Claims guideline
- Reviewed and processed pended Claims with high-dollar and complex claims that required manual pricing
- Worked adjustments, corrected claims and refunds.
- Generated, posted and attached information to claim files.
- Reviewed policy coverage details thoroughly before making determinations on benefits eligibility for each unique claim scenario presented.
- Facilitated communication between departments, ensuring timely resolution of outstanding claims.
- Maintained a high level of accuracy when inputting data into internal databases, ensuring all information was readily available for review by other team members as needed.
- Resolved complex claims issues for improved customer satisfaction and reduced claim backlog.
- Contributed to team success by sharing expertise on complex cases and collaborating on strategies to increase efficiency in case management tasks.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Evaluated and settled complex insurance claims in strict timeframes.
- Increased productivity by streamlining claim processing procedures and implementing time-saving technologies.
- Learned and adapted quickly to new technology and software applications.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Implemented quality control system for claim reviews, significantly improving accuracy of claim evaluations.
- Enhanced grievance appeals efficiency by streamlining processes and implementing best practices.
Claims Specialist
Beacon Health Options
09.2016 - 08.2020
- In addition to all Claim Processor I and II responsibilities (listed below):
- Processed complex and high dollar value Facility claims for the Medicaid program
- Processed claims from high-profile providers
- Worked on Customers’ inquiries
- Outreached with other departments involved during the claims investigation
- Analyzed and performed adjustment, correction, and reprocessed Complex claims with high dollar value and multiple claim lines, and range of DOS
- Maintain high production and quality standards
Claims Processor II
Beacon Health Options
06.2016 - 09.2016
- In addition to all Claim Processor I responsibilities (listed below):
- Processed moderately complex claims
- Researched claims for additional or missing information
- Analyzed and performed adjustment, correction, and reprocessed moderately complex claims
- Maintained high production and quality standards
Claims Processor I
Beacon Health Options
11.2015 - 06.2016
- Analyzed claims to determine the extent of the company's liability and make approval or denial decisions based on policy & procedures
- Engaged in inputting data into the processing system after interpreting medical coding and knowing terminology regarding procedures and diagnoses in medical professions
- Ensured to process assigned claim forms and inspect appropriate allocation of co-pays, deductibles, reimbursements, and co-insurance
- Complied with all judgmental policies and processes to assure appropriate claim payments
- Ensured complete Hand-off of assignments within and outside of the claims department
- Consistently met and exceeded productivity and quality requirements
- Trained on Processing UB, Adjustments, corrected and re-process claims
Laser Executive
Advanced Hair Studio
12.2014 - 03.2015
- Handled clients who signed up for Laser Therapy Treatment – set up accounts and session cards for new clients, updated their information to the system, gave instructions on how to use the supporting products, and scheduled payment plan
- Scheduled and confirmed appointments through phone calls
- Followed up with clients to make sure they come regularly and finish all the sessions within the time frame
- Maintained daily reports such as logbooks, sales, products issued, and Doctor’s reviews
Administration Executive
Vandaele Vietnam Co. Ltd.
04.2012 - 03.2014
- Used a variety of software packages, such as Microsoft Word, Outlook, PowerPoint, and Excel, to produce correspondence and documents and maintain presentations, records, spreadsheets, and databases
- Used content management systems to maintain and update websites and internal databases
- Sorted and distributed incoming posts and organized and sent the outgoing correspondences
- Attended and translated meetings between leadership and employees
- Organized and stored paperwork, documents, and computer-based information
- Recruited, trained, supervised junior staff, and delegated work as required
Team Leader
Masan Global Services
07.2011 - 03.2012
- Led a Team of 20 associates (Accounts Receivable Executives)
- Managed daily, weekly, and monthly reports such as productivity, quality, attendance, & ADHOC projects from the client
- Monitored work flow and assigned work to the AR Team
- Responded to inquiries in a timely manner, identify patterns and gaps to assist with training
- Handled associate escalations and co-ordinate with clients based in the USA
- Trained new employees on client specifics instructions
- Assisted management with team members’ communication
- Handled & escalated team queries with Human Resources and other relevant department
- Audited team members’ work for better quality and production improvement
Accounts Receivable Representative
Masan Global Services
11.2010 - 06.2011
- Trained in United States of America Healthcare Orientation – Specialized in Physician Billing
- Trained in Accounts Receivable Management – Collection process
- Trained in Soft Skills and Communication with US Customers – Voice & Accent
- Checked claims status and patient eligibility
- Analyzed Aging Report (Accounts with Outstanding balance to be collected from Health Insurance Companies), follow-up, and handled denied claims to get reimbursement
- Maintained higher standards of Quality set by the clients
- Followed HIPAA laws and regulations laid by the Federal and State governments
- Maintained cost-efficiency, such as saving call time and faster follow-up
- Built rapport with customers and clients for a smooth transaction
Education
High School Diploma -
Hoang Hoa Tham High School
Vietnam05-2006
Skills
- Claims analysis
- Microsoft office
- Confidentiality handling
- Claims investigation
- Time management
- Problem-solving abilities
- Multitasking Abilities
- Organizing and prioritizing work
- Critical thinking
- Claims processing
- Computer proficiency
- Reporting skills
- Great mathematical skills
- Claim amount calculations
- Insurance coverage verification
- Claims adjustment
- Verbal and written communication
- Organizational skills
References
- Medrano, Esparanza, Manager, Claims Administration, exmedran@texaschildrens.org
- Tamara L. Galleaud Timmons, Supervisor, Claims Administration, tlgallea@texaschildrens.org
Profiletraits
- Enthusiastic and dependable with training in finance science
- Coordinated all work to prevent errors and miscommunications
- Capable of performing work independently and efficiently
- Proficient in MS Office and computer programs related to insurance claims
- Excellent verbal and written skills in English and Vietnamese
- Work well under pressure, have a can-do attitude, fast learning, and welcome new challenges
Languages
Vietnamese
Native or Bilingual
Timeline
Claims Benefits Specialist
Texas Children's Health Plan
11.2021 - Current
Claims Specialist
Beacon Health Options
09.2016 - 08.2020
Claims Processor II
Beacon Health Options
06.2016 - 09.2016
Claims Processor I
Beacon Health Options
11.2015 - 06.2016
Laser Executive
Advanced Hair Studio
12.2014 - 03.2015
Administration Executive
Vandaele Vietnam Co. Ltd.
04.2012 - 03.2014
Team Leader
Masan Global Services
07.2011 - 03.2012
Accounts Receivable Representative
Masan Global Services
11.2010 - 06.2011
High School Diploma -
Hoang Hoa Tham High School
Similar Profiles
Myriam De La RosaMyriam De La Rosa
Senior Call Center Representative at Texas Children's Health PlanSenior Call Center Representative at Texas Children's Health Plan
Spencer GuhlSpencer Guhl
Intern at Texas Children's Health PlanIntern at Texas Children's Health Plan
Isabel CordovaIsabel Cordova
Sr Member Services Agent at Texas Children's Health PlanSr Member Services Agent at Texas Children's Health Plan