Jullyssa Rainey
Grovetown,GA
Summary
Passionate and professional Representative leads outreach efforts, strategic direction and day-to-day function management. Proven talent at building relationships and influencing others to gain support and commitment. Excellent presentation and communication skills and comfort working in fast-paced environment.
Approachable Medical Claims Processor proudly offering many years' experience in handling multiple administrative responsibilities in fast-paced office environments. Hardworking professional interacting with providers to discuss claim status or denials. Attentive to details and highly collaborative.
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
14
14
years of professional experience
Work History
Medical Claims Processor
Signature-Principle Choice Department of Veteran A
10.2023 - Current
- Reviewed medical claims for accuracy and completeness, verifying patient eligibility and coding.
- Ensured compliance with insurance company policies and procedures related to the processing of claims.
- Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
- Researched claim denials and appeals to determine appropriate resolution.
- Submitted electronic claims through various clearinghouses when necessary.
CAEC Representative
Department of Veterans Affairs Signature
Virtual , TX
12.2021 - 10.2023
- Answered questions and resolved concerns for customer support.
- Demonstrated exceptional service skills by going above and beyond to satisfy customers on phone and in person.
- Established relationships with existing customers to promote new product or service opportunities.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Communicated with other departments to establish action plans and manage open claims to closure.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Examined claims, records and procedures to grant approval of coverage.
Contact Representative-Lead
Department of Veteran Affairs
Denver, CO
02.2019 - 02.2020
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Strengthened operational efficiencies by developing organizational filing systems for confidential customer records and reports.
- Cultivated impactful relationships with customers and drove business development by delivering product knowledge.
- Documented conversations with customers to track requests, problems and solutions.
- Reviewed account and service histories to identify trends and issues.
- Fielded customer complaints and queries, fast-tracking them for problem resolution.
Supervisor
Teleperformance
Virtual , TX
10.2013 - 10.2018
- Complied with company policies, objectives and communication goals.
- Established and enforced clear goals to keep employees working collaboratively.
- Interviewed applicants, recommended individuals for hiring and evaluated staff performance.
- Provided ongoing training to address staff needs.
- Developed position rotation to support continuous improvement and operator development.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Documented conversations with customers to track requests, problems and solutions.
Office Manager
Phase 1
Harker Heights, TX
05.2012 - 10.2013
- Increased office organization by developing filing system and customer database protocols.
- Oversaw office inventory and timely reordering of supplies.
- Organized patient files and streamlined operations to improve efficiency.
- Monitored office inventory to maintain adequate supply levels and order products.
- Elevated customer satisfaction ratings by resolving client and case issues effectively.
- Recruited, trained and developed dynamic administrative team, supporting all corporate growth and productivity objectives.
Education
Associate of Applied Science - Medical Claims Examination
Strayer University
Washington, DCSkills
- Schedule mastery
- Report creation
- Materials transport
- Quality control
- Inbound and outbound calling
- Clerical support
- Credit card payment processing
- Active listening
- Promotional support
- Quality assurance controls
- Documentation Review
- Eligibility Determination
- ASC Coding
- Medical record review
- Insurance Claims
- Claim validity determination
- Insurance Verification
- ICD Codes
- Claims review
- Accuracy and precision
- Claims processing software
- Claims
Timeline
Medical Claims Processor
Signature-Principle Choice Department of Veteran A
10.2023 - Current
CAEC Representative
Department of Veterans Affairs Signature
12.2021 - 10.2023
Contact Representative-Lead
Department of Veteran Affairs
02.2019 - 02.2020
Supervisor
Teleperformance
10.2013 - 10.2018
Office Manager
Phase 1
05.2012 - 10.2013
Associate of Applied Science - Medical Claims Examination
Strayer University