Driven professional with a robust background in healthcare claims and appeals, notably with Blue Cross Blue Shield. Excelled in processing over fifty Medicaid Appeals Part B Claims, showcasing expertise in healthcare benefits and exceptional documentation skills. Renowned for outstanding case management abilities and a keen listener, consistently delivering results that exceed employer expectations.
Providing front line, direct contact with clients and customers. This is done through receiving or placing telephone calls, in addition to working faxes, electronic methods (e-mail & system of record task assignments), correspondence, mail, express delivery, reports, and project assignments.
Uses computerized system for tracking, information gathering and/or trouble shooting the items raised by the client/customer. Recognizes consistent problem areas and reports to higher level for action.
Seeks to retain account and/or suggest and encourage use of other services and products. Depending on area may promote and sell products and/or services and enter or confirm sales. Responds in a timely manner.
Follow standard procedures and policies with more senior levels using greater latitude and judgment in responding to customers. Provide collateral protection services by ensuring all customers are adequately insured as well as adding lender place insurance for uninsured customers.
Process over fifty Medicaid Appeals Part B Claims
Write letter templates on claims that are dismiss or denied
Process Claims that are aging or claims that will age
Providing information to customers about their Medicare plans and coverage options.
Reviewing applications to determine if applicants are eligible for coverage.
Answered inquiries from providers on the subject of claims , eligibility, covered benefits and approval status for veterans.
Read and assessed medical documents
Managed and process claims for veterans
Documented all activities through CRM
Answered telephone calls promptly and in an appropriate manner.
HealthCare Benefits
Claim Billing
Docuemntation
Email & Fax
Legal Documentation
Payroll & Payroll Processing
Policies
Sales
Proficient Typing
Case Management
Data Entry
Good listening Skills