Jessica Dean
Medical Claims Processor
Phoenix
Summary
Dependable, proven leadership professional Medical Claims Analyst with 3 years experience in successful time management and independent working experience progressive experience in the field who is highly organized and detail-oriented.
Overview
3
3
years of professional experience
4
4
years of post-secondary education
3
3
Certifications
Work History
Cognizant
Cognizant
Phoenix, AZ
10.2020 - 03.2022
- Pay or deny claims according to the benefit summary paper and electronic.
- Review membership eligibility for determination
- Assign the correct provider for proper payment
- Follow all HIPAA guidelines
- Review member's out of pocket for correct cost share application
- Review COB information and apply it accordingly
- Review Error codes, warning messages, and edits for correct processing
- Analyze claims for correct payment verification and adjust where needed
- Use the Facets system to adjudicate claims
- Calculated other insurance and benefits
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Posted and adjusted payments from insurance companies.
- Enter all correspondence/EOBs received into the computer.
- Update patient demographics, including insurance company information and financial class changes.
- Keep EOB review and interpretation current.
Service Desk Associate / Central Dispatcher
Amazon
Tempe, AZ
06.2019 - 08.2020
- Answers inquiries Coordinate rescue support between two drivers Interpret information from different sources to determine the best course of action todrive delivery success
- Communicate with delivery partners ensuring on-time delivery
- Solve for planned and unplanned events (traffic, weather, sporting, community)
- Reported traffic and transportation delays, accidents, and other issues
- Trained over 30 employees on accurate triaging and dispatching procedures while personally handling 30 daily calls
- Established schedules, implemented new policies, and collaborated with managers to improve operational procedures and set clear goals.
Claims Representative
WageWorks
Tempe, AZ
06.2017 - 03.2018
- Answered an average of 50 calls per day by addressing customer inquiries, solving problems, and providing new product information
- Described products to customers and accurately explained details and care of merchandise
- Follow all HIPA guidelines
- Review member's out of pocket for correct cost share application
- Review COB information and apply it accordingly
- Review Error codes, warning messages, and edits for correct processing
- Analyze claims for correct payment verification and adjust where needed
- Use of the Facets system to adjudicate claims
- Assign the correct provider for proper payment
- Follow all HIPAA guidelines
- Update patient demographics, including insurance company information and financial class changes.
- Calculated other insurance and benefits.
- Assign the correct provider for proper payment
- Follow all HIPAA guidelines
Education
High School Diploma -
Compadre High School
Tempe, AZ 08.2011 - 05.2015
CPC - Medical Insurance Coding
Coding Clarified
Apache Junction, AZ 03.2022 - 10.2022
Skills
HCPCS Level IIMedical terms and procedure knowledgeResults-orientedData entryConflict managementTime managementOrganizational skillsMedical SchedulingMicrosoft OfficeMedical TerminologyMedical BillingInsurance VerificationMicrosoft ExcelMedical RecordsEMR SystemsResearch
CMS
CVS Software Proficiency
Coverage assessments
Healthcare Common Procedures Coding System (HCPCS)
Epic Software Proficiency
Athena Software Proficiency
Explanation of Benefits (EOB)
Payment posting
Medicare and Medicaid process
CMS-1500 billing forms
Data Entry
Current Procedure Terminology (CPT)
Certification
High School - 2015
Timeline
CPC - Medical Insurance Coding
Coding Clarified
03.2022 - 10.2022
Cognizant
Cognizant
10.2020 - 03.2022
Service Desk Associate / Central Dispatcher
Amazon
06.2019 - 08.2020
Claims Representative
WageWorks
06.2017 - 03.2018
High School Diploma -
Compadre High School
08.2011 - 05.2015