Natalie Sampayan
Bakersfield,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.
Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously.
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.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Medical Claims Supervisor
Right Healthcare Inc.
02.2013 - Current
- Principal Duties and Responsibilities include managing 25-50 claims per day.
- Conduct audits of claims ensuring policies are being followed by staff while implementing plans of improvement.
- Thorough knowledge TPA, HMO, PPO, and CEDI/EDl electronic data interchange.
- Knowledge of PECOS registered physicians
- Maintain knowledge of benefits claim processing, claims principles, medical terminology, and procedures in accordance with HIPAA regulations.
- Verify patient insurance coverage and benefits for medical claims.
- Research and resolve complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Identified and resolved discrepancies between patient information and claims data.
- Assess medical claims for compliance with regulations and corrected discrepancies.
- Follow up on denied claims to verify timely patient payment and resolution.
- Respond to correspondence from insurance companies.
- Process insurance payments and maintained accurate documentation of payments.
- Check documentation for accuracy and validity on updated systems.
- Maintain confidentiality of patient finances, records, and health statuses.
- Maintain strong knowledge of basic medical terminology to better understand services and procedures.
- Prepare insurance claim forms or related documents and reviewed for completeness.
- Make contact with insurance carriers to discuss policies and individual patient benefits.
- Re-submit claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Assure timely verification of insurance benefits prior to patient procedures or appointments.
- Review outstanding requests and redirected workloads to complete projects on time.
- EMR and EHR
- Practice Management Software
- Master Patient Index
- Patient Portals
- Review authorization for release of medical information.
- Verified patient insurance coverage and benefits for medical claims
- Monitored and updated claims status in claims processing system
Claims Analyst
Managed Care Systems
03.2008 - 02.2012
- Viewed reports regularly to make sure processing was conducted efficiently.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Identified key areas not performing well and implemented effective, new processes.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Examined claims forms and other records to determine insurance coverage.
- Maintained claims data in cloud claims systems.
- Directed claims negotiations within allowable limit of $1500.00 and supported successful litigations for advanced issues
Education
Bachelor of Science - Business Administration
Liberty University
Lynchburg, VA06.2007
Skills
- Medical Terms and Procedure Knowledge
- Customer Service
- Customer Inquiries
- Prior Authorization Processing
- Electronic Claims Processing
- Patient Data Management Systems
- Accuracy Verification
- Reviewing Patient Information
- ICD-9/10-CM Coding
- Health Management Information Systems
- Medical Terminology
- Telephone Etiquette
- Claim Validity Determination
- Insurance Plan Verification
- Document Scanning
- Payment and Investigation Escalations
- Account Follow-Up
- Data Entry Accuracy
- Work Organizing and Prioritizing
- HIPAA Procedures
- Microsoft Access
- Thorough Claims Reviews
- Telephone etiquette
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Resolved product issue through consumer testing.
Certification
- BLS Certification
- AED Certification
- HMDR Dept. of Health Exemptee License
Timeline
Medical Claims Supervisor
Right Healthcare Inc.
02.2013 - Current
Claims Analyst
Managed Care Systems
03.2008 - 02.2012
Bachelor of Science - Business Administration
Liberty University
- BLS Certification
- AED Certification
- HMDR Dept. of Health Exemptee License
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