Kayla Lee
West Terre Haute,IN
Summary
Detail-oriented Claims Processor with a strong focus on accuracy, compliance, and efficient claims review. Proven ability to analyze trends and implement process improvements to enhance operational workflows.
Overview
4
4
years of professional experience
Work History
Claims Processor
Midcentral Health and Welfare
Terre Haute, IN
06.2022 - Current
- Process and review claims for accuracy and compliance with regulations.
- Investigate discrepancies and resolve issues to ensure timely claim resolution.
- Collaborate with healthcare providers to obtain necessary documentation and information.
- Implement changes to enhance efficiency in claims processing workflows.
- Utilize claims processing software to manage workflow and track claim statuses.
- Analyze trends in claims data to identify areas for process improvement.
- Developed strong relationships with healthcare providers and insurance agents to facilitate seamless communication during the claims process.
- Identified and reported potential fraud or abuse related to claims to protect system's integrity.
- Ensured compliance with all regulatory requirements, staying up-to-date with changes and conducting regular training.
- Calculated adjustments, premiums and refunds.
- Maintained confidentiality of patient finances, records, and health statuses.
Education
High School Diploma -
West Vigo High School
West Terre Haute, INSkills
- Claims review
- Accuracy and precision
- Transactions reconciliation
- Claims
- Professionalism and ethics
- Data entry proficiency
- Claims trend analysis
- Claims adjustment
- Active listening
- Microsoft office
- Prior authorization processing
- Recordkeeping organization
- Eligibility determination
- Paperwork processing
- Denied claims identification
- Documentation processing
- Teamwork and collaboration
Timeline
Claims Processor
Midcentral Health and Welfare
06.2022 - Current
High School Diploma -
West Vigo High School