Judy Ann Williams-Lee
North Olmsted,OH
Summary
Results-oriented professional with over 10 years of comprehensive claims support expertise, known for superior analytical, research, and problem-solving skills. Proficient in database updates, critical thinking, and issue resolution. Adept at educating clients on claims and building strong relationships with management, internal departments, and customers.
Twenty-one years in claims processing Proficiency in recovery, claims analysis, audit, data management and project oversight Leadership Strong communications skills Medical terminology and technical skills Customer relations Payment posting Computer proficiency in multiple software applications including MS Windows, MS Office Suite, MS Access, Visio, Visual Basic for Tapestry and IDX; on-base, right-fax, and web's, software; Sharepoint and Luminex Knowledge of third party administration/ancillary products, services, policies, procedures and systems Detail-oriented Claims Processor knowledgeable about automated systems and variations in plan benefits. Resolves high number of claims with fast and accurate analyses. Dependable in using proper classifications and meticulous recordkeeping.
Overview
19
19
years of professional experience
Work History
Medical Claims Adjustor
Enterprise Group
Solon
01.2018 - Current
- Processes and validates information for all medical claims through WebApp, including liability. Explains what is required to process claims and assists other processors via Luminex mainframe. Processes claims to Consumer or provider via explanation of benefits. Also, receipts uploaded via Wexapp database.
- Additionally, updates provider database within Luminex mainframe, allowing providers' addresses to be linked to correct claims to process payments to providers manually or electronically.
- Retrieve calls from members and providers to explain the summary of benefits. And liability to members under employer contract.
Recovery Specialist
Health Span Integrated Care
01.2008 - 01.2017
- Reviewed and analyzed healthcare claims for multiple claim error conditions; utilized HIPP A regulations in use and management of medical records (EMR) to maintain restrictions and avoid recovery errors; oversaw and enforced contract compliance for providers; researched and analyzed any overpaid accounts; uncovered and provided resolution to root causes of issues.
Claims Adjustor
Kaiser Permanente
01.2006 - 01.2008
- Reviewed claims for accuracy and overpayments; reconciled data in a direct collection system and accounting system to address discrepancies and reduce errors in processing and saving organization costs; developed provider education presentations with regard to payment and plan deductibles.
Education
Associate of Arts - Software Development
ITT Technical Institute
Cuyahoga Community College
Medical Assistance -
Cleveland Institute Medical and Dental Assistants
AAPC
Skills
- Proficiency in recovery
- Claims analysis
- Audit
- Data management
- Project oversight
- Leadership
- Strong communications skills
- Medical terminology and technical skills
- Customer relations
- Payment posting
- Computer proficiency in multiple software applications including MS Windows
- MS Office Suite
- MS Access
- Visio
- Visual Basic for Tapestry and IDX
- On-base
- Right-fax
- And multiple database
- Software
- and Luminal
- Knowledge of third party administration/ancillary products
- Services
- Policies
- Procedures and systems
- Conflict resolution techniques
- Medical terminology proficiency
- Strong analytical skills
- Effective communication abilities
- Data security procedures
- Insurance Claims
- Claim validity determination
- Telephone Etiquette
- Lapsed case follow up
- Medical Terminology
- Proficiency in Multiple Software
- Insurance Verification
- Organizational abilities
- Provider Relations
- HIPAA
- Insurance claims processing
- Critical Decision-Making
- Customer Service
Summaryofqualifications
- Twenty-one years in claims processing
- Proficiency in recovery, claims analysis, audit, data management and project oversight
- Leadership
- Strong communications skills
- Medical terminology and technical skills
- Customer relations
- Payment posting
- Computer proficiency in multiple software applications including MS Windows, MS Office Suite, MS Access, Visio, Visual Basic for Tapestry and IDX; on-base, right-fax, and web's, software; WexApp and Luminex
- Knowledge of third party administration/ancillary products, services, policies, procedures and systems
Timeline
Medical Claims Adjustor
Enterprise Group
01.2018 - Current
Recovery Specialist
Health Span Integrated Care
01.2008 - 01.2017
Claims Adjustor
Kaiser Permanente
01.2006 - 01.2008
Associate of Arts - Software Development
ITT Technical Institute
Cuyahoga Community College
Medical Assistance -
Cleveland Institute Medical and Dental Assistants
AAPC
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