JESSICA GARCIA
Odessa,Texas
Summary
Dynamic Medical Claims Processor with extensive experience at Family Health Administrators, adept at reducing claim processing time and enhancing customer satisfaction. Skilled in HIPAA compliance and critical decision-making, I effectively resolved complex claims issues, achieving a notable reduction in denied claims through meticulous attention to detail and proactive communication with providers.
Overview
20
20
years of professional experience
Work History
Medical Claims Processor
Family Health Administrators/City of Odessa
11.2004 - Current
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Reviewed provider coding information to report services and verify correctness.
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Identified and resolved discrepancies between patient information and claims data.
- Ensured compliance with all applicable regulations by maintaining strict adherence to HIPAA guidelines and company protocols when handling sensitive patient information.
- Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
- Resolved discrepancies between billed amounts and allowed charges promptly by working closely with both providers and payers, minimizing delays in payment processing times.
- Generated reports on medical claims processing activities and results.
- Provided exceptional support during audits by supplying detailed records of claim transactions as needed, ensuring full transparency into department operations.
- Stayed current on industry trends and changes in insurance policies, enabling accurate interpretation of coverage details for various plans.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Reduced turnaround time on claim payments by proactively identifying potential roadblocks and addressing them preemptively.
- Followed up on denied claims to verify timely patient payment and resolution.
- Handled escalated claims-related issues professionally, working diligently towards resolution while maintaining strong relationships with both clients and providers alike.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient finances, records, and health statuses.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Calculated adjustments, premiums and refunds.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Collaborated with healthcare providers to ensure accurate billing information was submitted, resulting in fewer denied or delayed payments.
Education
High School Diploma -
05-1986
- Honor Roll
- Professional Development: Business Professionals Association
- Ranked in Top 25% of class
- Business Professional's Association President
- Band
Skills
- Critical Decision-making
- ICD-10-cM coding
- Customer service
- Claim denial resolution
- HIPAA compliance awareness
- Medical record review
- Organizational growth
- Claims processing proficiency
- Insurance claims processing
- Thorough claims reviews
- Professionalism and ethics
- Continuous learning mindset
- Insurance verification
- HIPAA
- Medical terminology
- Fraud detection skills
- Medical coding expertise
- Telephone etiquette
- Provider relations
- Scrupulous records management
- Insurance claims
- Healthcare billing
- CPT code mastery
- Claim validity determination
- Electronic claims processing
- Insurance claims management
- Meticulous recordkeeping
- Electronic health records (EHR)
- ICD codes
- Teamwork and collaboration
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Claims investigation
- Organizing and prioritizing work
- Reliability
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Full TimeWork Location
On-SiteRemoteImportant To Me
Healthcare benefitsWork from home optionPaid time offWork-life balanceCareer advancementPaid sick leave401k match4-day work weekTeam Building / Company RetreatsCompany CultureTimeline
Medical Claims Processor - Family Health Administrators/City of Odessa
11.2004 - Current
Pecos High School - High School Diploma,
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