Pennie Spencer
5126 Balkin St,TX
Summary
Effective Medical Claims Processor with extensive experience at Texas Children's Hospital, adept in claims processing proficiency and customer service. Excelled in auditing for overpayments and ensuring HIPAA compliance, significantly reducing payment discrepancies. Demonstrated ability to manage high volumes of claims, enhancing efficiency and accuracy in a fast-paced environment.
Overview
9
9
years of professional experience
Work History
Medical Claims Processor
Texas Children's Hospital, TMC, CVICU
Houston, TX
03.2020 - Current
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Paid or denied medical claims based upon established claims processing criteria.
- Coordinated with other departments to ensure seamless integration of new policies and procedures, minimizing disruption to ongoing operations.
- Processed assigned claims.
- Checked documentation for accuracy and validity on updated systems.
- Reviewed provider coding information to report services and verify correctness.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Investigated overpayments and funds requirements.
Medical Claims Processor
UT Physicians
Houston, TX
01.2016 - 03.2020
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Paid or denied medical claims based upon established claims processing criteria.
- Processed insurance payments and maintained accurate documentation of payments.
- Identified and resolved discrepancies between patient information and claims data.
- Monitored and updated claims status in claims processing system.
- Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
- Posted payments to accounts and maintained records.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Verified client information by analyzing existing evidence on file.
Education
Jack Yates High School
Skills
- Auditing for overpayments
- Customer service
- Claim denial resolution
- HIPAA compliance awareness
- Claims processing proficiency
- Insurance claims processing
- Attention to detail
- Time management
- Funds Recovery
Timeline
Medical Claims Processor
Texas Children's Hospital, TMC, CVICU
03.2020 - Current
Medical Claims Processor
UT Physicians
01.2016 - 03.2020
Jack Yates High School