Savannah Warner
Bronte,TX
Summary
As a Claims Processing Specialist at Right Sourcing Solutions Ltd., I use specialized software to process incoming claims, enter data, and generate reports. I comply with regulations and guidelines related to claims processing to maintain quality and adherence to standards. I also review applications and supporting documents to verify claims eligibility and accuracy.
I have 5+ years of experience in customer service, claims management, and appeals functions, working with various insurance carriers and policies. I have developed and implemented quality assurance processes, created and maintained appeal response templates, and responded to customer inquiries, providing detailed explanations of insurance policies and claims processes. I have also contributed to increasing the user retention rate by 35% and reducing the outstanding debt by 75%. I hold a high school diploma and have skills in Epic Systems, MS4, and account management. I am motivated to leverage my skills and experience to achieve customer satisfaction and quality standards within your company.
Overview
8
8
years of professional experience
Work History
CLAIMS PROCESSING SPECIALIST I
RIGHT SOURCING SOLUTIONS
07.2023 - Current
- Utilized specialized software to process incoming claims, enter data and generate reports
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards
- Reviewed applications and supporting documents to verify claims eligibility and accuracy
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes
- Developed and implemented quality assurance processes to check accuracy of claims processing
- Monitored claims processing trends to identify potential areas of improvement
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
Patient Account Specialist I
River Crest Hospital
05.2022 - 07.2023
- Posted payments daily/ Sent out UB04s Daily
- Created, composed and maintained appeal response templates
- Acted as a departmental resource on appeals matters
- Developed appeals functions, policies and procedures and documentation
- Responded to attorney inquiries and litigation notices
- Prepared insurance claim forms or related documents and reviewed for completeness
- Posted payments to accounts and maintained records
- Made contact with insurance carriers to discuss policies and individual patient benefits
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt
- Assured timely verification of insurance benefits prior to patient procedures or appointments
- Coordinated with contracting department to resolve payer issues.
Claims Specialist (Medicaid/Medicare Contract)
Performant Recovery
08.2019 - 05.2022
- Sorted documents and maintained organized filing process
- Scanned documents and saved in database to keep records of essential organizational information
- Posted payments upwards of $50,000.00 towards Medicare accounts collected from physicians accounts
- Created 300+ Excel documents yearly to assist with pulling metrics data and presenting information to our team of doctors for concise explanations of best placement for needed resources
- Participated in requirements meetings and data mapping sessions to understand business needs
- Produced 22 monthly reports using advanced Excel spreadsheet functions
- Answered 500+ calls monthly on multi-line phone systems, routing calls, delivering messages to staff and greeting visitors
- Executed record filing system to improve document organization and management
- Sent 25-30 emails daily demonstrating mastery of written communication and attention to detail
- Scheduled and coordinated virtual and in-person meetings, ALJ court hearings, travel and appointments for 30-person department
- Organized and managed sensitive data input in over 12 excel spreadsheets, retrieving and delivering information quarterly or as needed
- Created more efficient workspace by proactively anticipating department needs
- Conducted full claim investigations and reported updates and legal actions.
Health Care Billing Specialist
Sitel
08.2015 - 08.2019
- Submitted verbal and written notification to members and providers
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments
- Processed and finalized appeals and grievances within agreed-upon turnaround time
- Entered appeal requests in appeals module
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses
- Conducted full claim investigations and reported updates and legal actions
- Researched claims and incident information to deliver solutions and resolve problems
- Handled complaints and grievances using negotiating and problem-solving skills
- Examined claims forms and other records to determine insurance coverage
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Education
Robert Lee High School
05.2014
Programs Experience
- MS4 for managing claims
- Waystar for Insurance verification and EOB/UB04
- Avality for insurance and appeals
- Individual insurance portals
- Microsoft office/ Excel/Outlook
- Epic
- CPR+
Timeline
CLAIMS PROCESSING SPECIALIST I
RIGHT SOURCING SOLUTIONS
07.2023 - Current
Patient Account Specialist I
River Crest Hospital
05.2022 - 07.2023
Claims Specialist (Medicaid/Medicare Contract)
Performant Recovery
08.2019 - 05.2022
Health Care Billing Specialist
Sitel
08.2015 - 08.2019
Robert Lee High School
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