Letresa Roberson
Jacksonville,FL
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
25
25
years of professional experience
Work History
Medical Claims processor
Brighton Health Plan Solution
12.2023 - Current
- Gathers clinical information for cases/routed to appropriate area to refer or assign case (utilization management, case management, QI, Med Review)
- Provides network providers or general program information when requested
- Acted as liaison between Medical Management and/or Operations and internal departments
- Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information/ Prepares reports and documents all actions
- Navigate multiple software programs and windows on multiple screens simultaneously
- Knowledge of medical billing, CPT codes and ICD 9 and 10 coding
Utilization Mgt Rep 1
BC Forward (Elevance Health)
07.2023 - 04.2024
- Gathers clinical information for cases/routed to appropriate area to refer or assign case (utilization management, case management, QI, Med Review)
- Provides network providers or general program information when requested
- Acted as liaison between Medical Management and/or Operations and internal departments
- Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information/ Prepares reports and documents all actions
- Navigate multiple software programs and windows on multiple screens simultaneously
- Knowledge of medical billing, CPT codes and ICD 9 and 10 coding
Claims Examiner
Aetna
11.2021 - 04.2023
- Process 40 to 50 Medicare and Medicaid claims per day using Rumba sessions 99% accuracy
- Triage held claim/research claim and resolve all holds to allow the claim to processed
- Process Commercial medical claims/ Process Medicaid claims
- Responsible for meeting productivity, financial and procedural accuracy standards/goals
- Knowledge of medical billing/CPT and ICD 9/10 coding
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Reviewed provider coding information to report services and verify correctness.
- Monitored and updated claims status in claims processing system.
- Researched and resolved complex medical claims issues to support timely processing.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Followed up on denied claims to verify timely patient payment and resolution.
- Processed insurance payments and maintained accurate documentation of payments.
- Verified patient insurance coverage and benefits for medical claims.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Identified and resolved discrepancies between patient information and claims data.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Prepared [Type] documents for managers or legal personnel.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Handled [Type] calls from customers and other stakeholders about [Type] processes.
- Examined claims forms and other records to determine insurance coverage.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Collected [Type] information from customers to complete claims and legal files.
- Maintained claims data in [Type] systems.
Customer Care Rep I
Anthem/Ingenio Rx
04.2021 - 10.2021
- Years Customer Service/ Healthcare plans/ Managed Care Medicare/ Medicaid Products/Inbound Pharmacy Second Level calls/
- Utilize several systems to research, resolve and solve pharmacy issues
- Written and oral communication skills/ Microsoft Office skills/
- Ability to manage multiple tasks and priorities
Medical Claims Examiner/Processor
Dell/NTT Data
10.2014 - 10.2021
- Processed 100 to 150 claim per day 97% accuracy/ Medical terminology knowledge
- Three plus years' experience of processing Medicaid claims'
- Five plus processing Commercial medical claims/Knowledge of medical billing/CPT and ICD 9 coding
- Ability to Multi-task, prioritize work and manage time/Effective oral and written communication skills
Cust. Svc/ Medical Records/ Clinical Support
Florida Blue
03.2005 - 05.2014
- 10 plus years Customer Service/ FEP, Commercial, Medicare Over 65/ HMO
- Inbound call center for providers/updating authorizations/creating authorization
- Processed Blue Square claims/ Sent DFs to home plan/held/suspended claims
- Provide timely responses to customer's (internal/external) via phone, email, written and webmail
- Handled provider/members/external customers complaints, appeal and disputes
- Organizational skills/Written and oral communication skills/Manage multiple tasks and priorities
Assistant Office Manager
Milton Salvage
01.2000 - 01.2005
- AP/AR, Filing, Data Entry, Booking, Billing Clerk
- Reviewed orders, Prepared spreadsheet, Power Points, Charts for office meetings/
- Review expense reports and documents and process invoices for payment/refunds
- Maintain expense reports and appropriate documentation and process invoices for payment
- Analyzing internal reports/ compile in data spreadsheet/ maintained inventory via online
Education
High School -
Charlton County High School
Folkston, GASkills
- Six Sigma Yellow Belt
- Oracle
- Microsoft Word
- Microsoft Excel
- Microsoft Express
- Microsoft Power Point
- Insurance claims
- Customer service
- Electronic health records (EHR)
- Records security practices
- Insurance claims processing
- Medical terminology
- ICD codes
- Meticulous recordkeeping
- Telephone etiquette
- Critical Decision-making
- Provider relations
- Thorough claims reviews
- Electronic claims processing
- Medical record review
- HIPAA
- Insurance verification
- Claim validity determination
- Insurance claims management
Timeline
Medical Claims processor
Brighton Health Plan Solution
12.2023 - Current
Utilization Mgt Rep 1
BC Forward (Elevance Health)
07.2023 - 04.2024
Claims Examiner
Aetna
11.2021 - 04.2023
Customer Care Rep I
Anthem/Ingenio Rx
04.2021 - 10.2021
Medical Claims Examiner/Processor
Dell/NTT Data
10.2014 - 10.2021
Cust. Svc/ Medical Records/ Clinical Support
Florida Blue
03.2005 - 05.2014
Assistant Office Manager
Milton Salvage
01.2000 - 01.2005
High School -
Charlton County High School
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