Ruby Speights
Glen Allen ,VA
Summary
To effectively demonstrate my communication skills in a professional environment with an opportunity for growth and knowledge. Authorized to work in the US for any employer. Experienced Medical Claims Examiner with 4 years of expertise in processing and adjudicating medical claims, ensuring accuracy and compliance. Proficient in medical coding, claim analysis, and resolution, resulting in high-quality outcomes. Recognized for exceptional accuracy, problem-solving abilities, and strong attention to detail. Completed CPC certification and healthcare claims management course to enhance skills. Proven track record of implementing process improvements, reducing errors, and increasing efficiency. Fluent in English and Spanish. Enthusiastic about joining a dynamic team where I can contribute to accurate and efficient claim processing, making a positive impact on patients' lives.
Overview
16
16
years of professional experience
Work History
Claims Processor
Firstsource Solutions
03.2024 - Current
- Reviewing medical claims processing claims in a timely manner.
- Determine adherence to standard guidelines, ensure the timeliness of claims processing
- Processing 200 - 300 claims daily
- Using knowledge of medical terminology and insurance information to process claims
- Working with client Healthfirst processing commercial Medicaid and
- Reviewed denial claims and provided the coverage
- Denied and approved claims
- Using excel spreadsheet to provide the correct amount to process claims
- Knowledge of Adobe Reader
Claims Representative
Sutherland Global Services
09.2022 - 12.2024
- Reviewed insurance claims to assess their validity, ensure compliance with policy terms, and determine appropriate resolutions.
- Process 16 claims per hour
- Ensure great quality and productivity processed behavior mental claims and also priced claims
- Interpreting policy language and legal frameworks to determine if a claim is covered and to what extent the insurer is liable
- Processed professional and Ub04 claims
Retail Banker
WoodForrest
11.2014 - 12.2019
- Processes a variety of customer transactions accurately and efficiently in adherence to bank policies and regulations such as cashing checks, processing deposits and withdrawals, loan payments, cash advances, transfers, and issuing monetary instruments.
- Addresses customer questions and concerns by phone and in person; files disputes or refers to appropriate internal resources for resolution as appropriate.
Customer Service Representative
Maximus Call Center
09.2017 - 05.2019
- Follow policies and standard operating procedures such as filling out timesheets, adhering to privacy rules and responding to numerous phone inquiries.
- Utilize standard technology such as telephone, e-mail, and web browser to perform job duties.
- Assist caller(s) with filling out online applications and submitting electronically to plan provider for processing.
- Complete basic call log related to the phone inquiries such as clicking radio buttons to confirm which scripts were read to the caller
- Refer calls as required to CSR Lead
- Maintain up-to-date knowledge of client regulations and policies
- Report problems that occur via the online system so they can be addressed by the appropriate parties
Eligibility Specialist
Anthem, Inc.
02.2013 - 12.2015
- Eligibility specialists determine whether or not applicants for various programs meet the necessary qualifications.
- Evaluated eligibility for public assistance programs, including Medicaid, SNAP, and TANF.
- Assessed financial and personal information of applicants to ensure compliance with program regulations.
Sales Representative
Fios
01.2009 - 01.2012
- Collected customers feedback and process changes to accounts. Generate cable, phone and internet plans as well as process payments via phone. Schedule service calls for techs to go out to address problems
Education
Diploma - undefined
Century College
Richmond, VA06.2013
HIGH SCHOOL DIPLOMA - undefined
GEORGE WYTHE HIGH SCHOOL
06.2010
Skills
- Ms office
- Organizational skills
- ICD-10
- Insurance verification
- Time management
- Publisher
- Data Entry
- Customer service
- Typing
- Freight Experience
- Medical office experience
- Microsoft Excel
- ICD coding
- Adobe Acrobat
- CPT coding
- Computer Skills
- Medical terminology
- Medicare
- Microsoft Office
- Medical records
- Microsoft Word Patience Attentiveness Time Management Power Point Excel MS Office Publisher Outlook 10 Key Touch Customer Service Certification
- Anatomy knowledge
- Medical billing
- Medical collection
- Banking
- Outlook
- Microsoft Word
- Excel
- Medical coding
Timeline
Claims Processor
Firstsource Solutions
03.2024 - Current
Claims Representative
Sutherland Global Services
09.2022 - 12.2024
Customer Service Representative
Maximus Call Center
09.2017 - 05.2019
Retail Banker
WoodForrest
11.2014 - 12.2019
Eligibility Specialist
Anthem, Inc.
02.2013 - 12.2015
Sales Representative
Fios
01.2009 - 01.2012
Diploma - undefined
Century College
HIGH SCHOOL DIPLOMA - undefined
GEORGE WYTHE HIGH SCHOOL
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