Professional equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
3
3
years of professional experience
Work History
Medical Claims Specialist
ProviDrsCare Network/Unified Health Plan
10.2023 - Current
Repriced and adjudicated a large volume of medical claims on daily basis according to each provider's fee schedule and client's benefit contract.
Responded to telephone calls and emails from insurance companies, providers, and clients.
Maintained knowledge of benefits, claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Paid or denied medical claims based upon established claims processing criteria.
Evaluated medical claims for accuracy and completeness and researched missing data.
Verified patient insurance coverage and benefits for medical claims.
Medical Office Specialist
Wesley Family Medicine
02.2022 - 10.2023
Answered phone calls and messages for 35-physician family practice entailing scheduling appointments, handling patient inquiries, offer office information, answer questions, schedule appointments, and direct calls to staff.
Adhered to strict HIPAA guidelines to protect patient privacy.
Updated patient information and insurance details by scanning and uploading forms to their respective locations to upkeep accurate medical records
Provided prompt, polite and professional in-person and telephone customer service.
Performed various administrative tasks by filing, copying and faxing documents.
Clinical Operations Analyst/Authorization Coordinator at Sentara Health Plan/Virginia Premier Health PlanClinical Operations Analyst/Authorization Coordinator at Sentara Health Plan/Virginia Premier Health Plan
Transition Care Coordinator at Virginia Premier Health Plan/Sentara Health PlanTransition Care Coordinator at Virginia Premier Health Plan/Sentara Health Plan
Talent Acquisition | Recruiter at Health Plan of San Joaquin - Mountain Valley Health PlanTalent Acquisition | Recruiter at Health Plan of San Joaquin - Mountain Valley Health Plan