Monet Manning
Jacksonville,FL
Summary
Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success.
Overview
8
8
years of professional experience
Work History
Senior Provider Reimbursement/Claims Specialist
NAVY FEDERAL CREDIT UNION
02.2021 - 05.2023
- Ensured contracted rates and reimbursement policies were priced and applied accurately
- Initiate and respond to written and verbal communications from internal and external sources
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Analyzed provider reimbursement patterns
- Extensive Knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and HCPCS
- Support continuous improvement by identifying process improvements and/or quality enhancements
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
Claims Processor
United Health Group
01.2018 - 12.2020
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement
- Maintained detailed records of all processed claims for easy retrieval during audits or disputes.
- Evaluated medical records accurately to determine appropriate coverage and payment for claims, leading to increased customer satisfaction.
Insurance Claims Representative
Amerihealth Caritas
12.2014 - 12.2017
- Negotiated settlements for uncomplicated claims in accordance with actual company liability
- Analyzed financial data related to claims expenses, making recommendations for cost-saving measures
- Drafted statements of loss to summarize payments, underlying policy coverage and damages.
- Expedited claim payments by effectively managing workload priorities and keeping accurate documentation records.
- Worked productively in fast-moving work environment to process large volumes of claims.
Education
High School Diploma -
Andrew Jackson High School
Jacksonville, FL05.2007
Skills
- Documentation Review
- Proficient with PC's and in Windows based environments; including Microsoft Office (Word, Excel, Outlook)
- Experience in revenue cycle credit balance
- Critical Thinking
- Data Entry Softwarew
- Proficient in the Epic software
- Eligibility Determination
- Data Analysis
- Claims Processing
- Knowledgeable of medical terminology, procedure and denial codes
- Claims Investigation
Timeline
Senior Provider Reimbursement/Claims Specialist
NAVY FEDERAL CREDIT UNION
02.2021 - 05.2023
Claims Processor
United Health Group
01.2018 - 12.2020
Insurance Claims Representative
Amerihealth Caritas
12.2014 - 12.2017
High School Diploma -
Andrew Jackson High School
Similar Profiles
Windi NuseWindi Nuse
Member Service Representative V at Navy Federal Credit UnionMember Service Representative V at Navy Federal Credit Union
Jessica JacksonJessica Jackson
Member Service Representative at Navy Federal Credit UnionMember Service Representative at Navy Federal Credit Union
London ParkerLondon Parker
Fraud Prevention Specialist at Navy Federal Credit UnionFraud Prevention Specialist at Navy Federal Credit Union
Noah CarterNoah Carter
Member Service Representative II at Navy Federal Credit UnionMember Service Representative II at Navy Federal Credit Union
Johnathan DavisJohnathan Davis
Hazardous Materials Specialist at U.S NavyHazardous Materials Specialist at U.S Navy