Ia Vang
Elk Grove,CA
Summary
Dedicated and compassionate individual looking to bring my excellent manner to your company where my skills, abilities and experiences will be utilized to its fullest. Detailed claims processor with several years of experience investigating claim information for correctness. Trustworthy teammate with benefit knowledge and rapport-building skills. Noted for thoroughness and ethical customer service.
Overview
7
7
years of professional experience
Work History
Claim Liaison
Centene Corporation
Sacramento, CA
10.2021 - Current
- Process pending medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility.
- Applied policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied.
- Actively participated in team meetings aimed at improving overall efficiency within the department.
- Identified discrepancies between documentation submitted and actual payments made in order to prevent payment errors.
- Analyzed claim data to identify areas of concern or potential cost savings opportunities.
- Identified and flagged suspicious claims for further investigation.
- Followed up on pending claims and resolved issues delaying processing.
- Collaborated with adjusters and underwriters to resolve complex claim issues.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
Revenue Recognition Specialist
Kids Care Dental & Orthodontics
Rancho Cordova, CA
06.2018 - 03.2020
- Billed primary and secondary insurance claims in a timely and accurate manner utilizing the electronic billing systems.
- Confirm and correct any patient demographic and insurance data entry errors to ensure clean claims.
- Post payments from EOB's by insurance carriers based on PPO insurance and making any necessary adjustments and documenting appropriately.
- Resolved any claim errors on the billing system in a timely manner by reviewing claim error reports and taking appropriate action.
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Investigated incorrect billings and processed refunds as necessary.
- Performed insurance verification, pre-certification and pre-authorization.
- Checked claims coding for accuracy with ICD-10 standards.
- Submitted claims to insurance companies.
Education
Associate of Fine Arts -
International Academy of Design and Technology
Sacramento03.2015
High School Diploma -
Oroville High School
Oroville, CA06.2013
Skills
- Claims processing
- Medical billing
- Data analysis
- Policy application
- Claim investigation
- Insurance verification
- Critical thinking
- Team participation
- Claims analysis
- Claims processing software
- Payments posting
- Computer proficiency
- Customer service
- Insurance coverage verification
References
Reference upon request
Timeline
Claim Liaison
Centene Corporation
10.2021 - Current
Revenue Recognition Specialist
Kids Care Dental & Orthodontics
06.2018 - 03.2020
Associate of Fine Arts -
International Academy of Design and Technology
High School Diploma -
Oroville High School
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