John Speights III

• Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
• Used administrative guidelines as resource or to answer questions when processing medical claims.
• Responded to correspondence from insurance companies.
• Followed up on denied claims to verify timely patient payment and resolution.
• Researched and resolved complex medical claims issues to support timely processing.
• Verified patient insurance coverage and benefits for medical claims.
• Reviewed provider coding information to report services and verify correctness.

• Adhere to payer guidelines for appeals submission and escalate exhausted appeal

efforts for resolution

• Assist in data gathering and reporting of non-authorizations, appeals and provider

disputes.

• Follow-up on all outstanding insurance claims, which include correspondence, denials

and rebills.

• Prepare reviews for cases that do not meet the required criteria and Maintain files and

logs related to all appeals.

• Followed up with customers on unresolved issues.
• Evaluated and settled complex insurance claims in strict timeframes.
• Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
• Maintained confidentiality of patient finances, records, and health statuses.
• Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.