Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kelsey Hall

Lakewood,CO

Summary

Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.

Overview

5
5
years of professional experience

Work History

Medical Claims Analysis

United Health Group, Optum
07.2019 - Current
  • Enhanced claim processing efficiency by implementing automated workflows and streamlining procedures.
  • Reduced fraudulent claims by conducting thorough investigations and collaborating with the fraud detection team.
  • Improved customer satisfaction by resolving complex medical claims in a timely and professional manner.
  • Ensured accurate payments by meticulously reviewing medical records, invoices, and supporting documentation.
  • Managed high-volume caseloads for optimal productivity while maintaining strict attention to detail.
  • Achieved successful resolutions on disputed claims through effective collaboration between internal departments such as legal counsel and clinical experts.
  • Managed large volume of medical claims on daily basis.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Spoke with Nurses within the company to identify charges that are adjusted
  • Handled not warranted claims, Corrected claims and Duplicates
  • Entered claims into the company system from the patients Universal Bill
  • Evaluated medical claims for accuracy and completeness and researched missing data.

Medical Sales Agent

Mesa Labs
10.2018 - 07.2019
  • Enhanced client satisfaction by promptly addressing inquiries and providing accurate information on products and services.
  • Expanded customer base through effective networking, cold calling, and relationship-building strategies.
  • Streamlined internal processes for improved efficiency and productivity within the agency.
  • Assisted clients in navigating the claims process, ensuring timely resolution of issues and optimal outcomes.
  • Delivered exceptional customer service by proactively addressing concerns and fostering a positive experience throughout all interactions.
  • De-escalated and resolved customer complaints with punctual, polite and professional service.
  • Resolved caller issues quickly and thoroughly.
  • Entered Orders into the system

Education

High School Diploma -

Lakewood High School
Lakewood, CO
05.2017

Skills

  • Training and mentoring
  • Fraud detection techniques
  • HIPAA Compliance Understanding
  • Healthcare regulations knowledge
  • Insurance Policies Knowledge
  • Claims Processing Proficiency
  • Knowledgeable in Excel, Outlook & PCOMM
  • Critical Thinking
  • Medical Terminology Familiarity

Timeline

Medical Claims Analysis

United Health Group, Optum
07.2019 - Current

Medical Sales Agent

Mesa Labs
10.2018 - 07.2019

High School Diploma -

Lakewood High School
Kelsey Hall