Jennifer Bledsoe
Rowlett,TX
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.
Overview
11
11
years of professional experience
Work History
Medical Claims Examiner - Remote
AmeriHealth Caritas
04.2021 - Current
- Paid or denied medical claims based upon established claims processing criteria.
- Verified patient insurance coverage and benefits for medical claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Managed large volume of medical claims on daily basis.
- Reviewed provider coding information to report services and verify correctness.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Researched and resolved complex medical claims issues to support timely processing.
Medical Claims Examiner - Remote
NTT DATA Formerly Dell Services
03.2018 - 02.2021
- Processed Blue Cross Blue Shield Medicare of Michigan medical claims for retired School Teachers and General Motor workers. Processed HCFA's and UB Hospital claims in timely manner using IKA claims processing systems
Medical Claims Examiner
Web Tpa\Kforce
11.2017 - 02.2018
- Paid or denied medical claims based upon established claims processing criteria.
- Verified patient insurance coverage and benefits for medical claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
Senior Medical Claims Examiner
Cicerone Health Solutions
07.2014 - 05.2017
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Researched and resolved complex medical claims issues to support timely processing.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Responded to correspondence from insurance companies.
Medical Biller, Validator, Customer Service
Christus Health
03.2013 - 07.2014
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Posted payments and collections on regular basis.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Documented entire validation process, noting changes or alterations completed.
Education
High School Diploma -
Marlin High School
Marlin, TXSkills
- Medical Terminology
- Insurance Claims Processing
- Medical Terms and Procedure Knowledge
- Claims Processing
- Customer Service and Support
- HIPAA
- Claims Adjustment
- Payment Processing
- Thorough Claims Reviews
Timeline
Medical Claims Examiner - Remote
AmeriHealth Caritas
04.2021 - Current
Medical Claims Examiner - Remote
NTT DATA Formerly Dell Services
03.2018 - 02.2021
Medical Claims Examiner
Web Tpa\Kforce
11.2017 - 02.2018
Senior Medical Claims Examiner
Cicerone Health Solutions
07.2014 - 05.2017
Medical Biller, Validator, Customer Service
Christus Health
03.2013 - 07.2014
High School Diploma -
Marlin High School
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