Sharon Prior
San Jose,CA
Summary
Claims Analyst with 5 years of experience consistently perform core responsibilities without direct supervision; very comfortable with processes and subject matter associated with this role.
Overview
26
26
years of professional experience
Work History
Claims Analyst
Excel MSO / Optum Health
10.2020 - Current
- Processes all types of medical claims and adjust medical disputed claims [professional and Facility] according to department, contract, and regulatory requirements.
- Analyze and identify trends and provide reports as necessary
- Meet quality standard of 98% with 150 claim production daily.
- Mentored new hires, resulting in stronger staff development and increased productivity.
Medical Claims Examiner
Silicon Valley Medical Development
08.2019 - 09.2020
- Reviewed and adjudicated claims for medical services in accordance with provider contracts and authorizations.
- Provide customer service to providers and members.
- Identifying causes of incorrect action taken on denied claim and reprocessing claims per contract benefits.
- Initiated and prepared outgoing mail pertaining to explanation of benefits, member and provider denials.
Physician Billing Specialist
Verity Medical Foundation
03.2018 - 08.2019
- Analyze payment history, explanation of benefits and other documentation to distinguish over payment amounts
- Collected and pasted payments.
- Communicated with insurance providers to resolve denied claims.
Laboratory Office Assistant
Novant Health Presbyterian Hospital
08.1997 - 12.2012
- Maintained physical and digitized records organized for easy updating and retrieval by authorized team members.
- Formulated detailed recommendations based on audit findings to support annual planning and definition of goals.
Education
Diploma - Medical Insurance Billing And Coding
Institution of Business And Technology
San Jose, CA03.2018
Diploma - Certificated Nursing Assistant
Rowan-Cabarrus Community College
Salisbury, NC01.1998
Skills
- Knowledgeable in ICD-10, CPT/ HCPC coding guidelines, medical terminology and managed care principles
- Experience with multiple Medicare and commercial health plans to include; Alignment, United Healthcare, Caremore, Scan, Med-connect, HealthNet, and Anthem Blue Cross/Shield
- Knowledge and background using claim processing systems to include IDX, QuickCap, Sharepoint, MEDISoft, Macess and Encoder,
Timeline
Claims Analyst
Excel MSO / Optum Health
10.2020 - Current
Medical Claims Examiner
Silicon Valley Medical Development
08.2019 - 09.2020
Physician Billing Specialist
Verity Medical Foundation
03.2018 - 08.2019
Laboratory Office Assistant
Novant Health Presbyterian Hospital
08.1997 - 12.2012
Diploma - Medical Insurance Billing And Coding
Institution of Business And Technology
Diploma - Certificated Nursing Assistant
Rowan-Cabarrus Community College
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