Shanna Savone
Riverside,CA
Summary
Highly-motivated Claims Examiner with a desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
10
10
years of professional experience
Work History
Claims Examiner
Medix Staffing - Avesis
Riverside, CA
02.2024 - Current
- Review medical records and documents to determine coverage eligibility of claims for insurance benefits.
- Investigated discrepancies in claims and resolved issues with customers via telephone or written correspondence.
- Assessed accuracy of claim payments by comparing submitted bills to benefit allowance guidelines.
- Processed appeals from denied claims according to established procedures while ensuring compliance with applicable laws and regulations.
- Processed appeals from denied claims according to established procedures while ensuring compliance with applicable laws and regulations.
- Created reports on rejected claims, including statistical analysis of trends in rejections.
- Provided guidance to other staff members regarding claim processing rules and regulations.
- Evaluated requests for pre-certification and authorization services, determining appropriate reimbursement levels based on contractual agreements between providers and payers.
Claims Examiner
Medix Staffing - Angle Health
Riverside, CA
10.2023 - 02.2024
- Initiated contact with providers to obtain additional information needed for accurate adjudication of claims.
- Conducted audits of claim files to ensure adherence to departmental standards.
- Reviewed medical records and documents to determine coverage eligibility of claims for insurance benefits.
- Performed data entry into the computer system to record information regarding claim status.
- Investigated discrepancies in claims and resolved issues with customers via telephone or written correspondence.
- Managed workloads efficiently by prioritizing tasks based on urgency or importance.
- Paid and processed claims within designated authority level.
- Double-checked and reviewed documentation for denied and accepted insurance claims.
Claims Adjuster
LA Care
Los Angeles, CA
04.2019 - 09.2023
- Investigated insurance claims, reviewed coverage and liability, prepared reports and recommended payment or denial of claims.
- Researched relevant laws, regulations, legal decisions and precedents to determine appropriate course of action.
- Reviewed medical records, police reports and other documents related to claim investigations.
- Maintained accurate documentation of all claim activity within designated system.
- Assisted colleagues with difficult cases; provided guidance regarding complex issues or scenarios.
- Adhered strictly to departmental guidelines; ensured that all activities were compliant with applicable state laws.
Clinical Administrative Coordinator
United Healthcare
Phoenix, AZ
01.2014 - 12.2018
- Prepared and maintained various reports for management regarding clinical activities.
- Assessed the appropriateness of length of stay for inpatient admissions.
- Handled incoming phone calls from providers and responded to inquiries accordingly.
- Monitored compliance with HIPAA regulations in regards to patient privacy rights.
- Analyzed medical records to ensure compliance with regulatory requirements.
- Developed clinical criteria for authorization decisions based on accepted standards of practice.
- Communicated authorization decisions to providers and patients in a timely manner.
Education
Bachelor of Science - Health Administration
University of Phoenix
Tempe, AZ05-2026
Skills
- Data Verification
- Policy Interpretation
- Insurance knowledge
- Verbal Communication
- Microsoft Office Suite
- Claims Processing
- Investigative skills
- Coverage Assessment
- File and Record Management
- Active Listening
- Critical Thinking
- Claims Evaluation
- Claim Form Analysis
References
References available upon request.
Timeline
Claims Examiner
Medix Staffing - Avesis
02.2024 - Current
Claims Examiner
Medix Staffing - Angle Health
10.2023 - 02.2024
Claims Adjuster
LA Care
04.2019 - 09.2023
Clinical Administrative Coordinator
United Healthcare
01.2014 - 12.2018
Bachelor of Science - Health Administration
University of Phoenix
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