Nicole Edwards
927 SW Burt ,OK
Summary
Seasoned Claims Adjuster and Medical Billing Manager with a proven track record at United Healthcare Group. Expert in claims investigation and processing, leveraging critical thinking and active listening to enhance compliance and revenue. Achieved significant reductions in denied claims and optimized cash flow, demonstrating strong negotiation and relationship-building skills.
Overview
17
17
years of professional experience
Work History
Claims Adjuster
United Healthcare Group
01.2016 - Current
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
- Evaluated medical claims to determine coverage and liability, ensuring compliance with policy terms.
Medical Billing Manager
Self Employed
05.2008 - 01.2025
- Reviewed billing problems, researched issues, and resolved concerns.
- Worked with customers to develop payment plans and bring accounts current.
- Increased patient satisfaction by addressing billing inquiries promptly and professionally.
- Developed strong relationships with insurance companies through effective communication and negotiation skills, enhancing payment turnaround times.
- Reduced denied claims through diligent review, correction, and resubmission of errors.
- Streamlined claim appeals process by creating clear documentation guidelines and templates for staff use.
- Enhanced revenue cycle management by overseeing timely and accurate claims submission.
- Maintained up-to-date knowledge of regulatory changes impacting medical billing practices to ensure ongoing compliance within the organization.
- Optimized cash flow by regularly reviewing aging account balances and implementing tactics for timely collections from patients or insurers.
Education
High School Diploma -
Red Mountain High School
Mesa, AZ05.2001
Skills
- Critical thinking
- Claims investigation
- Active listening
- Claims processing
- Highly motivated
- Team collaboration
- Advanced oral and written communication skills
- Decision-making
- Policy interpretation
- Regulatory compliance
Timeline
Claims Adjuster
United Healthcare Group
01.2016 - Current
Medical Billing Manager
Self Employed
05.2008 - 01.2025
High School Diploma -
Red Mountain High School
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