Lowen Karnes
Lake Elsinore,CA
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. Talented Manager with expert team leadership, planning and organizational skills built during successful career. Smoothly equip employees to independently handle daily functions and meet customer needs. Diligent trainer and mentor with exceptional management abilities and results-driven approach.
Overview
15
15
years of professional experience
Work History
CPQ Phyician/Hospital Claims Processor
United Health Care
01.2017 - Current
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Calculated adjustments, premiums, and refunds.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Evaluated accuracy and quality of data entered into agency management system.
Fuel Station Manager
Vons
01.2008 - 12.2016
- Trained new employees on proper protocols and customer service standards.
- Assisted in recruiting, hiring and training of team members.
- Delegated daily tasks to employees, streamlining daily progress and efficiency.
- Reduced financial inconsistencies while assessing and verifying billing invoices and expense reports.
- Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service.
- Managed purchasing, sales, marketing and customer account operations efficiently.
Education
State License - Treatment Operator/ 1 Ca Water Resources Board
Certificate - Internet Authoring
Certificate - Internet And Web Technologies
Skills
- New Policies Processing
- Fluent Microsoft Office
- Understanding of CPT and DX Medical Codes
- Managing Operations and Efficiency
- Contract Development and Management
- Office and team Management
- Managing Appointments
- Finance and Accounting Operations
- Policy Enforcement
- Issue and Conflict Resolution
- Performance Tracking and Evaluations
- Focus and Follow-Through
Timeline
CPQ Phyician/Hospital Claims Processor - United Health Care
01.2017 - Current
Fuel Station Manager - Vons
01.2008 - 12.2016
Mount San Jacinto College - State License, Treatment Operator/ 1 Ca Water Resources Board
Mount San Jacinto College - Certificate, Internet Authoring
Mount San Jacinto College - Certificate, Internet And Web Technologies
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