J. Denise Barnes
Temple,TX
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Experienced Claim Examiner with over 10+ years of experience. Excellent reputation for resolving problems and improving customer satisfaction.
Overview
11
11
years of professional experience
Work History
Patient Financial Services Representative
Elevate Patient Financial Services LLC
07.2022 - 10.2023
- Conducted research, gathered information from multiple sources to process claims and to resolve CRMs from basic ro complex situations on a daily basis either to pay or deny medical claims based upon established claims processing criteria, guidelines , and procedures.
- Reviewed and re processed denied claims from different reports in addition to regular claim processor criteria mentioned in previous position.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
Claim Examiner
Pearl Network
01.2021 - 06.2022
- Reviewed, analyzed, investigate, and processed all types of medical and transplant claims by following procedures and guidelines.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Directed and coordinated various investigations conducted by Payment Integrity Team.
- Prepared material for audits and provided assistance to lead and Supervisor during audits.
- Handled high dollar and transplant cases and made recommendations to ensure appropriate and timely claims payments.
- Referred eligibility, authorization, benefits,and pricing information to determine appropriate course of action(i.e. claim reject/denial, request for additional information, request for refund. etc.)
Certified Medical Assistant
Family Medicine Clinic
05.2015 - 12.2017
- Answered multi-line phone system to respond to inquiries and transfer calls to correct departments and personnel.
- Monitored office supplies by checking inventory and placing orders.
- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Maintained transaction security by verifying payment cards against identification.
- Used internal software to process registrations, check-ins and check-outs.
- Resolved customer issues quickly and notified supervisor immediately when problems escalated.
- Confirmed relevant member information and payment methods to prevent fraud.
- Communicated clearly and effectively with patients to verify information, determine purpose of visit and record medical history.
- Promoted office efficiency, coordinating charts, completing insurance forms, and helping patients with diverse needs.
Freight Broker Agent
YellowRose Logistics LLC
05.2012 - 11.2016
- Created documents of load plans, cargo cleanliness inspections, and transportation processes.
- Negotiated and arranged transport of goods with shipping or freight companies.
- Checked import and export documentation to determine cargo contents and classified goods into different tariff or fee groups.
- Utilized computer systems to manage cargo shipments and accurately track goods.
- Operated cargo handling equipment to facilitate safe and quick loading and unloading of cargo.
Education
Associate of Applied Science - Criminal Justice
Central Texas College
Killeen, TX05.2008
Skills
- Responsible
- Interpersonal Communication
- MS Office
- Good listening skills
- Information Collection
- Collaboration
- Team building
- Training & Development
- Reading comprehension
- Professional ethics understanding
Additional Information
Reference will be provided upon request
Timeline
Patient Financial Services Representative
Elevate Patient Financial Services LLC
07.2022 - 10.2023
Claim Examiner
Pearl Network
01.2021 - 06.2022
Certified Medical Assistant
Family Medicine Clinic
05.2015 - 12.2017
Freight Broker Agent
YellowRose Logistics LLC
05.2012 - 11.2016
Associate of Applied Science - Criminal Justice
Central Texas College
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