Summary
Overview
Work History
Education
Skills
Timeline
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Ramona Lee

Middletown,NY

Summary

Organized, driven and adaptable with excellent planning and problem solving abilities. Successful at managing high caseloads in fast paces environments. Experienced in insurance verification, coordination of benefits and pre-authorizations. Computer proficiency, Microsoft Word and Excel. Great communication skills. Experienced in medical terminology, ICD 10, CPT , HCPS coding and HIPPA.

Overview

17
17
years of professional experience

Work History

Medical Claims Adjuster

Healthfirst
New York
10.2012 - 01.2024
  • Familiarized with contractual provisions and authorization necessary for adjusting claims denied / incorrectly processed
  • Used administrative guidelines as resources to reprocess claims
  • Participated in handling complex and special projects authorized final disposition of claim withing guidelines
  • Managed large volume of adjustments on a daily basis

Customer Service

Healthfirst
New York
08.2010 - 10.2012
  • Utilized Microsoft windows oƯice programs to complete required administrative tasks
  • Performed problem solving skills daily to maintain departmental customer quality care
  • Experienced in analyzing and solving customer service inquiries
  • Practiced time management eƯiciently

Child Care Caseworker

Gabrial House
Hinesville, GA
03.2007 - 05.2009
  • Developed healthy relationships with children; provide support and guidance
  • Observed ad prepared daily case notes on each client
  • Enforced rules and maintained safe environment
  • Used positive reinforcement techniques to promote patience and other good behaviors in clients

Substitute Teacher

Hinesville Bord of Education
Hinesville, GA
03.2007 - 05.2009
  • Developed rules and set goals to maintain in classroom
  • Followed classroom plans left by class teacher to continue student education and reinforce core concepts
  • Educated students in various subjects to provide seamless transition during absence of head teacher
  • Took notes and prepared reports on school day activities to provide to primary teacher

Education

ASSOCIATE OF SCIENCE - HUMAN SERVICES

SUNY EMPIRES STATE COLLEGE
SARATOG SPRINGS, NY

Skills

  • Healthcare billing
  • Conflict resolution techniques
  • Problem solving prowess
  • Data entry efficiency
  • ICD-10 coding
  • Critical thinking aptitude

Timeline

Medical Claims Adjuster

Healthfirst
10.2012 - 01.2024

Customer Service

Healthfirst
08.2010 - 10.2012

Child Care Caseworker

Gabrial House
03.2007 - 05.2009

Substitute Teacher

Hinesville Bord of Education
03.2007 - 05.2009

ASSOCIATE OF SCIENCE - HUMAN SERVICES

SUNY EMPIRES STATE COLLEGE

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Ramona Lee