LaSheik Calhoun
Winston-Salem,NC
Summary
Highly trained Claims Specialist with expertise in Medicare Advantage claims processing and adjusting. Diplomatic and personable professional accustomed to handling sensitive, confidential information by facilitating timely claims resolution. Committed to maintaining customer satisfaction and contributing to company success.
Overview
6
6
years of professional experience
Work History
Claims Specialist
Blue Cross NC
10.2022 - 04.2024
- Initiated and responded to faxed and written correspondence from medical providers to ensure timely reimbursement
- Collaborated with interdisciplinary teams to ensure smooth processing and accurate reimbursement of medical claims.
- Researched, adjudicated and resolved Medicare Advantage claims within Amisys and Macess claims processing applications to support timely processing.
- Handled complex Medicare claims with multiple parties involved, effectively managing priorities and deadlines to ensure timely resolutions.
Provider Customer Service Representative
Blue Cross NC
01.2020 - 08.2021
- Developed rapport with providers through active listening and empathetic communication, resulting in enhanced satisfaction levels.
- Safeguarded confidential member information by adhering to strict privacy guidelines and protocols.
- Educated providers on medicare billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
Claims Specialist
Aetna
07.2018 - 01.2020
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Skillfully navigated Medicare/Medicaid regulations in order to secure maximum reimbursement rates for qualifying services provided.
- Served as subject matter expert on hospital claims processing, providing guidance to colleagues seeking assistance with challenging cases or unique scenarios.
- Improved claim processing efficiency by accurately reviewing and validating hospital claims for reimbursement.
Education
Certificate - Medical Terminology
Forsyth Technical Community College
Winston-salem, NCCertificate - Pharmacy Technology
Forsyth Technical Community College
Winston-salem, NCSkills
- Claims Processing
- Microsoft Office
- Critical Thinking
- Documentation skills
- Medicare Compliance
- Medicare Advantage Understanding
- Medicare/Medicaid
- HIPAA Compliance
- Claims adjustment
- Data Entry
- ICD-10 Proficiency
- Accuracy and Precision
Timeline
Claims Specialist
Blue Cross NC
10.2022 - 04.2024
Provider Customer Service Representative
Blue Cross NC
01.2020 - 08.2021
Claims Specialist
Aetna
07.2018 - 01.2020
Certificate - Medical Terminology
Forsyth Technical Community College
Certificate - Pharmacy Technology
Forsyth Technical Community College