Janet S Goodwin
Platte City,MO
Summary
Claims professional who values precision and efficiency in claims evaluation and resolution. Experience in managing high caseloads and settling claims accurately in compliance with company standards. Able to collaborate with team members and adapt to changing needs, ensuring reliable performance and positive results.
Organized and dependable with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
25
25
years of professional experience
Work History
Claims Adjustor
Government Employees Health Association
01.2012 - 12.2024
- Processed overseas claims beginning January 2017 through December 2024
- Processed specialty claims such as mental health/RTC, renal dialysis & advanced radiology (MRI, CT) in addition to regular medical, hospital & vision claims
- Obtained & verified pre-authorization for inpatient stays, physical therapy and advanced radiology charges
- Medicaid reimbursements and payment calculation
- Coordinating benefits with secondary carriers as well as Medicare & Medicaid
- Communicated with members and providers via email due to them being located overseas
Claims Payor
UFCW Local 576
11.2011 - 12.2011
- Enter and adjudicate medical, hospital and dental claims
- Verify pre-certifications with case management
Health and Welfare Claims Examiner
Boilermakers National Funds
01.2000 - 01.2011
- Diagnosis, CPT/HCPCS and revenue coding for medical, hospital/facility and vision claims
- Provider verification and necessary updates
- Multiple surgery claims
- Transplant coding and travel reimbursement
- Mental health/substance and methadone claims
- Adjudicating pending, closed out and new batched claims
- Prompt Pay, Out of Network and Aged claims reports
Skills
- Efficient claims processing
- Keyboarding proficiency
- Experienced in claims processing systems
Training
- HIPPA Compliance Certified - Training Course
- Proficient in Microsoft programs (Word, Excel, Outlook)
- Facets, Macess, ClaimFacts & ClaimFlow claims processing systems
Timeline
Claims Adjustor
Government Employees Health Association
01.2012 - 12.2024
Claims Payor
UFCW Local 576
11.2011 - 12.2011
Health and Welfare Claims Examiner
Boilermakers National Funds
01.2000 - 01.2011
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