Ranae Miller
Dallas,Tx
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Exemplary worker with highly investigative skills when processing claims. Highly skilled healthcare professional with expertise in medical, dental, and prescription claims. Adept in various roles such as Medical Enrollment Processor, Certified Pharmacy Technician, Certified Medical Biller and Coder, Appeals and Billing Denial Associate, Account Receivable Specialist, and Claims Adjudicator. With over 10 years of experience in the medical field, possesses a deep understanding of the industry's intricacies.
Overview
14
14
years of professional experience
Work History
Claims Analyst, Billing Representative III
Optum360
09.2019 - 08.2024
- Reviewed and solved account and billing discrepancies.
- Trained new hires on company-specific billing software, policies, and procedures, promoting team cohesion and productivity.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Worked effectively with medical payers such as Medicare, Medicaid, and commercial insurances to obtain timely and accurate payments.
- Maintained up-to-date knowledge of industry trends and regulatory changes, applying insights to enhance claim processing effectiveness.
Certified Pharmacy Technician III/Claims appeal representative
DavitaRx
12.2014 - 08.2019
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Successfully processed escalations for appeals and claims maintaining professional demeanor.
- Trained new pharmacy technicians on proper procedures and best practices, ensuring consistent quality of service.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Completed paperwork, entering prescription and insurance or billing information into patient profiles.
Manager Revenue Cycle Operations
HealthMarkets
01.2011 - 10.2014
- Improved management decision-making with detailed operational and risk reports
- Accomplished multiple tasks within established timeframes.
- Recruited, trained personnel and managed performance evaluations
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
Education
Associate of Applied Science - Health Administration
North Lake College
Irving, TXSkills
- Billing and Coding
- Claims analysis
- Interpersonal and written communication
- Policy Interpretation
Timeline
Claims Analyst, Billing Representative III
Optum360
09.2019 - 08.2024
Certified Pharmacy Technician III/Claims appeal representative
DavitaRx
12.2014 - 08.2019
Manager Revenue Cycle Operations
HealthMarkets
01.2011 - 10.2014
Associate of Applied Science - Health Administration
North Lake College
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