Kim Swann
Columbus,GA
Summary
Claims Analyst with over 29 years of experience at Paragon Benefits, the TPA industry. I am skilled in claims processing and data analysis. Demonstrated expertise in medical coding and regulatory compliance, achieving performance metrics through meticulous review and effective communication. Adept at problem-solving and negotiation, ensuring timely resolutions, and customer satisfaction. Committed to maintaining high standards in all aspects of claims management. I work remotely, independently, and maintain my daily production, along with inquiries that are sent for review, research, and resolution daily. I have been trained in the HIPAA Accountability Act of 1996.
Overview
28
28
years of professional experience
Work History
Claims Analyst
Paragon Benefits
Columbus, GA
11.1996 - Current
- Analyzed claim data for completeness, enhancing overall processing efficiency.
- Determined coverage and liability according to plan documents and benefits.
- Achieved performance metrics through thorough and diligent claims review.
- Applied medical terminology and coding expertise during claims processing.
- Handled voids and refunds received for client accounts efficiently.
- Streamlined input of claim information and payments into the company database for optimal tracking.
- Nine years Virtual Adminstration (VBA)
Education
High School Diploma -
Jordan Vocational High
Columbus GA06-1983
Skills
- Claims processing and coverage determination
- Claims expertise in the following: Hospital, professional, dental, Medicare claims
- Coordination of benefits
- Data analysis and interpretation
- Medical coding and regulatory compliance
- Performance metrics and risk assessment
- Attention to detail and problem solving
- Critical thinking and analytical skills
- Effective communication and negotiation techniques
- Customer service and support
- Professional demeanor and teamwork
- Document workflow and investigation reporting
- Settlement negotiation and case review
Timeline
Claims Analyst
Paragon Benefits
11.1996 - Current
High School Diploma -
Jordan Vocational High
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