RYAN DEFINIS
Church Hill,TN
Summary
Experienced medical claims specialist with strong analytical skills, adept at managing complex claim processes and ensuring compliance with industry regulations. Focused on team collaboration and achieving results, consistently adapting to changing needs. Skilled in claims adjudication, customer service, and detailed documentation. Reliable and driven to contribute effectively in fast-paced environments
Overview
6
6
years of professional experience
Work History
Medical Claims Representative
ITX Companies
Kingsport
10.2023 - Current
- Processed up to 60 medical claims efficiently each day, ensuring compliance with payer policies and guidelines.
- Analyzed claim data to identify discrepancies and resolve issues promptly.
- Maintained accurate records of claims status, ensuring timely follow-up on outstanding items.
- Collaborated with team members to streamline workflows and enhance processing accuracy.
- Provided training support for new staff on claims processing procedures and best practices.
- Implemented process improvements that reduced claim turnaround times significantly.
- Communicated effectively with healthcare providers for documentation and clarification needs.
- Responded to patient concerns and questions with compassionate and knowledgeable service.
- Trained new staff on best practices for patient advocacy and support strategies.
Fraud Specialist
Advanced Call Center Technologies
Johnson City
07.2021 - 10.2023
- Analyzed fraud patterns to identify and mitigate risks effectively.
- Developed training materials for new staff on fraud prevention techniques.
- Analyzed transaction patterns to identify potential fraudulent activities and mitigate risks.
- Enhanced customer satisfaction through prompt resolution of reported fraudulent transactions and clear communication with clients. Averaging over 50 inbound calls per day.
- Analyzed transaction data to identify emerging trends in fraud tactics, enabling proactive response to potential threats.
Professional Shopper
Food City
Kingsport
07.2020 - 07.2021
- Provided exceptional customer service, resolving issues promptly to retain customer loyalty.
- Maintained high satisfaction ratings by completing orders quickly and making good selections for customers.
- Reviewed approximately 40 customer orders per day closely to locate desired items and checked app regularly to identify changes.
- Demonstrated speed and accuracy in order item selection.
- Consistently met deadlines and quality goals for accuracy and timeliness.
- Loaded and unloaded orders at customer's homes or locations.
- Assisted in training new hires on store protocols, fostering a supportive learning environment for all employees.
Education
Associates in Art - Technology Management
Pasco-Hernando State College
New Port Richey, FL08-2016
Skills
- HIPAA compliance
- Claims processing
- Microsoft office
- Follow-up skills
- Medical billing
- Customer service
- Knowledgeable in Excel
- Telephone etiquette
- ICD codes
- Task prioritization
Timeline
Medical Claims Representative
ITX Companies
10.2023 - Current
Fraud Specialist
Advanced Call Center Technologies
07.2021 - 10.2023
Professional Shopper
Food City
07.2020 - 07.2021
Associates in Art - Technology Management
Pasco-Hernando State College