Iyanah Fletcher
Healthcare
Sacramento,CA
Summary
Effective Medical Claims Processor with strong background 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. Contributes strong analytical skills and extensive knowledge of medical billing and coding in the healthcare industry. Seeking to apply expertise in reviewing and processing medical claims accurately and efficiently, ensuring compliance with industry standards and regulations, while delivering exceptional service to both healthcare providers and patients.
Overview
24
24
years of professional experience
Work History
Medical Claims Examiner
UFCW Trust Fund
1999.05 - 2024.01
- Claims Processing: expertise in preparing, analyzing, and adjusting claims while adhering to current Plan rules and regulations, demonstrating strong skill set in claims processing and compliance
- Accuracy and Attention to Detail: verifying accuracy of information, determining current eligibility under plan design, calculating benefits, and reviewing claims for completeness, highlighting importance of meticulous attention to detail
- Versatility and Collaboration: determining member coverage, coordinating with other carriers and third-party administrators, and assisting with special projects and Member Services, emphasizing adaptability, teamwork, and willingness to take on diverse responsibilities
- System Testing: conducted comprehensive testing on updated system, evaluating its performance, functionality, and compatibility with existing applications
- This involved rigorous testing procedures to ensure seamless integration and smooth operation within upgraded environment
- Payment Integrity Team: Addressed any over or under payments based on reason codes on any adjusted claims
- Also worked credit back reports received from Third Parties
- I carefully reviewed medical claims to identify instances where payment exceeded correct amount based on providers
- Support Team: Handled escalated issues for Member Service Team by assisting and addressing concerns raised by members and providers
- Collaborating with the MSR's suggests a connection between the support function and the broad service oriented team, possibly involving coordination on member & provider related issues
- This collaboration is crucial to ensuring seamless experience and addressing their needs effectively.
- Processed all statements on in house and discharged patients
- Behavioral Health Services rendered - TARS are sent to counties for Medi-Cal & requests are submitted HMO, PPO using Admission/Billing systems along with my knowledge of third party payment procedures, managed care and government programs
- Maintained Accounts Receivable through follow up and collection activity including letters, telephone, and personal contact
- Maintains patients financial file and documentation informs patient, guarantor in regard to hospital financial policies
- FedEX Overnight, and Electronically emailed Medical Records for approval if needed/requested
- Uploaded to counties for approval after discharge and received processed approved TARS through Kepro/Acentra system
- Demanded and dropped UB04 claim through Waystar
- Pulled Medicare remittance using Waystar eSolutions
- Availity used to verify mental health benefits
- Submitted Appeal TARS if denied by counties through Kepro/Acentra
- Tracked Appeals 1st level/2nd level using Midas
- Approved TARS/Authorization received we follow up with counties and HMO/PPO's for collection
- AR will set up payment plans after insurance paid through self pay
- Every Thursday we have AR meeting with high level staff COO,CFO and Directors of Contracts, Business Office and Admissions to go over accounts net balance or if it should be submitted to Bad Debt Portal
Customer Service Representative/Billing Specialist
PROTEMP STAFFING SOLUTIONS
1998.07 - 1999.05
- Foundation Health/Health Net - duties were customer service to members & providers, verifying eligibility and discussing any billing issues, and entering open enrollment forms
- Integrated Pharmaceutical Services- Assisted pharmacists with processing prescriptions by identifying errors identified according to plan guidelines.
Medicare Claims Specialist
Medicare Risk Senior Advantage Kaiser Permanente
1998.08 - 1999.04
- Processed paperless claims, workload received within the system Adjudicated th claims information populates based upon diagnosis and services rendered claim would suspend or pay
- Had access to a query (microfilm) to view related documents immediately.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
Admitting Clerk/Medical Assistant
UCD Medical Center
1997.01 - 1998.08
- Effectively registered patients, created identification cards, generated medical record numbers
- Verifying insurance and authorizations, obtaining room assignments for inpatient confinement's, and assembling charts
- Taking vitals, documenting charts, rooming patients.
- Verified patient details and insurance coverage and collected co-pays.
- Developed strong rapport with patients and family members, ensuring a compassionate and professional atmosphere during the admissions process.
Education
Medical Assistant - Medical Assisting
High Tech Institute
Sacramento, CA05.1996
Highschool Diploma -
Woodridge
Sacramento, CA05.1995
Skills
- Analytical skills
- Attention to detail
- Knowledge of medical coding
- Understanding of insurance policies
- Effective communication
- Familiarity with industry regulations
- Ability to assess claims for accuracy and compliance
- Proficient in data entry and accuracy in financial transactions
- Familiarity with billing software and systems
- Strong attention to detail to identify discrepancies and errors
- Excellent organizational skills to manage invoices and records
- Knowledge of basic accounting principles
- Effective communication skills for interacting with clients and colleagues
- Ability to prioritize tasks and meet deadlines
- Understanding of confidentiality and integrity in handling financial information
- Microsoft Outlook Word/Excel/PowerPoint
- Medical Billing/Scheduling/Filing
- Medical Terminology
- Insurance Verification
- Payment Integrity handling credit backs, refunds, under & over payments
- Medical Office/Hospital Experience
- ICD 9/10, HCPC codes
- HIPAA Compliance
- Team Collaboration
- Healthcare industry understanding
- Payment Processing
- Insurance collaboration
- Collections experience
- Administrative Support
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Timeline
Medical Claims Examiner
UFCW Trust Fund
1999.05 - 2024.01
Medicare Claims Specialist
Medicare Risk Senior Advantage Kaiser Permanente
1998.08 - 1999.04
Customer Service Representative/Billing Specialist
PROTEMP STAFFING SOLUTIONS
1998.07 - 1999.05
Admitting Clerk/Medical Assistant
UCD Medical Center
1997.01 - 1998.08
Medical Assistant - Medical Assisting
High Tech Institute
Highschool Diploma -
Woodridge
Similar Profiles
Beth SorensenBeth Sorensen
Enrollment Department Head at UFCW Trust FundEnrollment Department Head at UFCW Trust Fund
Ibrahim Tukura DanjumaIbrahim Tukura Danjuma
Intern at Internshıp Trust Fund (ITF)Intern at Internshıp Trust Fund (ITF)
ELSIE AKOTO ESHUNELSIE AKOTO ESHUN
Assistant Manager - Repayment & Recovery at Student Loan Trust FundAssistant Manager - Repayment & Recovery at Student Loan Trust Fund