Josephine Banks
Philadelphia,PA
Summary
Highly skilled in analytical thinking, effective communication, and collaborative teamwork. Track record of seamlessly adapting to new environments. Enthusiasm to contribute to team success and enhance professional skills is unwavering. Positive attitude and strong commitment to continuous learning and growth. Eager to make a valuable impact in any organization joined.
Overview
6
6
years of professional experience
Work History
Clinical Appeals Representative
United Healthcare
09.2022 - Current
- Reviewed incoming appeals and determined their urgency and priority based on medical necessity and regulatory requirements
- Collaborated closely with healthcare providers, clinical staff, and insurance companies to gather necessary documentation for appeals
- Developed and implemented a systematic approach to triage denied claims, ensuring prompt identification of priority cases
- Maintained detailed records of appeal cases, including status updates, communications, and outcomes.
Medical Claims Specialist
Penn Medicine
07.2019 - 07.2022
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures, and HIPAA regulations
- Submitted electronic/paper claims documentation for timely filing
- Followed up on potentially fraudulent claims initiated by claims representatives
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Claims Processor
Rothman Orthopaedics
04.2019 - 05.2022
- Evaluated accuracy and quality of data entered into the agency management system, achieving a 98% accuracy rate on over 2,000 entries per month.
Followed up with customers on unresolved issues, resulting in a 30% increase in customer satisfaction scores and a reduction in outstanding claims by 25%.
- Collaborated with the claims department and industry anti-fraud organizations to resolve claims, successfully identifying and mitigating fraud in 15% of processed claims.
- Contacted insurance carriers to discuss policies and individual patient benefits.
Education
High School Diploma -
New Foundations Charter High
Philadelphia, PA06.2021
Skills
- Data Management
- Microsoft Office
- Scheduling
- Documentation
- Meeting Participation
- Coordination
- Triage
- Monitoring
- Compliance
- Adaptability
- Multitasking
- Excellent Communication
Professionaloverview
A dedicated and detail-oriented Clinical Appeals Representative with a strong background in healthcare administration, medical billing, and insurance claims. Possessing exceptional analytical and communication skills, I am committed to advocating for patients and healthcare providers by meticulously reviewing denied claims. With a deep understanding of medical coding, insurance policies, and regulatory compliance, I excel in navigating complex healthcare systems to secure favorable outcomes for all parties involved.
Timeline
Clinical Appeals Representative
United Healthcare
09.2022 - Current
Medical Claims Specialist
Penn Medicine
07.2019 - 07.2022
Claims Processor
Rothman Orthopaedics
04.2019 - 05.2022
High School Diploma -
New Foundations Charter High