Keionia Braxton
Antioch,CA
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.
Overview
25
25
years of professional experience
Work History
Claims Processor
Kaiser Permanente
Walnut Creek, CA
10.2016 - Current
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Evaluated accuracy and quality of data entered into agency management system.
- Paid or denied medical claims based upon established claims processing criteria.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient finances, records and health statuses.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Checked documentation for accuracy and validity on updated systems.
- Prepared insurance claim forms or related documents and reviewed for completeness.
Pharmacy Clerk
Kaiser Permanente
Walnut Creek, Martinez, CA
05.2014 - 10.2016
- Prepared packaging and labels for prescriptions, verifying accuracy of dosage, side effects, interactions and refill instructions.
- Communicated instructions to patients or caregivers about proper use and storage of drugs.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Established and maintained patient profiles, updating organizational database with current information.
- Supported pharmacists with day-to-day activities and pharmacy office management functions.
- Completed cash register transactions by handling credit and cash payments using pharmacy register system.
- Maintained records of prescriptions filled for patients by completing pharmacy log and updating customer accounts.
- Handled inventory stock by counting inventory items, checking delivery quantities, reviewing medication expirations and ordering additional products.
- Located and processed ready prescriptions to customers, distributed medication information documentation and facilitated medication consultations.
- Received and processed stock into inventory management system.
- Boosted sales and delivered outstanding customer service by assisting customers with pharmacy services, product questions and general store information.
- Processed payments, returns and exchanges using pharmacy POS system to accurately manage transactions.
- Answered customer questions regarding prescribed medications, over-the-counter products, and insurance coverage.
Unit Clerk
Kaiser Permanente
Santa Clara, CA
05.2000 - 05.2014
- Answered unit calls and took messages for healthcare staff to maximize team productivity.
- Provided clerical support, addressing routine and special requirements.
- Coordinated diagnostic tests, collection of samples and transportation to scanning rooms.
- Prepared admissions charts and scanned records.
- Monitored and communicated patient dietary plans to carry out physician orders and prevent errors.
- Answered multi-line telephone system, provided information and directed calls.
- Documented updates to patient information in medical charts while maintaining HIPAA compliance protecting confidentiality of records.
- Responded to and resolved diverse patient issues with speedy and knowledgeable assistance.
- Obtained and organized medical records for office visits and scheduled labs.
- Interacted with members by phone, email or in-person to provide information.
- Arranged discharges and patient transportations.
- Orchestrated efficient and thorough replenishment of unit supplies to handle forecasted patient loads.
- Greeted visitors and initiated triage processes for patients to streamline patient flow.
- Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Registered and verified patient records before triage with most up-to-date information.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Collaborated with assistants and doctors to prepare and set up rooms with adequate supplies and equipment.
- Placed new supply orders, managed inventory and restocked clerical spaces.
- Contacted hospitals to confirm patients medical histories and prevent inaccurate diagnoses and treatments.
Education
No Degree - General Studies
Foothill College
No Degree - Hospital Unite Clerk
San Mateo County ROP
Skills
- Self-Motivated
- Dependable and Responsible
- Decision-Making
- Claims review
- Patient contact
- Data integrity
- Clerical Support
- Active listening
- Critical thinking
Timeline
Claims Processor
Kaiser Permanente
10.2016 - Current
Pharmacy Clerk
Kaiser Permanente
05.2014 - 10.2016
Unit Clerk
Kaiser Permanente
05.2000 - 05.2014
No Degree - Hospital Unite Clerk
San Mateo County ROP
No Degree - General Studies
Foothill College
Software
Microsoft Office
Mainframe Foundation
Microsoft Excel
Microsoft Teams
Personal Information
Title: Claims Processor