Job Search Status
Open to workDesired start date: Immediately
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Shelly Gettig
Centre County,PA
Work Preference
Summary
Detail-oriented professional with extensive experience in medical claims processing. Proven skills in problem-solving, customer service, and team training, contributing to increased accuracy and reduced claim rejections.
Overview
6
6
years of professional experience
Work History
Medical Claims Processor
Accordia National Insurance
Charleston, WV
07.1993 - 09.1995
- Processed medical claims efficiently, ensuring compliance with regulatory requirements and company policies.
- Reviewed documentation for accuracy, reducing claim rejections through meticulous attention to detail.
- Coordinated with healthcare providers to resolve discrepancies and expedite claim approvals.
- Trained new team members on claims processing procedures and software systems, enhancing team productivity.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Collaborated with healthcare providers to ensure accurate billing information was submitted, resulting in fewer denied or delayed payments.
- Identified and resolved discrepancies between patient information and claims data.
- Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Refund Specialist
Accordia National Insurance
Charleston, WV
06.1991 - 07.1993
- Processed refund requests efficiently, ensuring compliance with company policies and procedures.
- Reviewed claims for accuracy, identifying discrepancies and coordinating resolutions with relevant departments.
- Increased productivity by effectively managing workload and prioritizing tasks.
- Maintained accurate records and ensured timely completion of all necessary paperwork.
- Received and reviewed incoming documents and materials.
- Assisted colleagues as needed, fostering a positive work environment based on teamwork and mutual supportiveness.
- Provided outstanding customer service by promptly addressing inquiries and resolving issues.
- Demonstrated flexibility when adapting to new processes or guidelines while maintaining consistently high levels of productivity.
- Reduced errors with meticulous attention to detail and thorough review of documentation.
- Prepared reports and technical documentation of day-to-day production processes.
Employment Service Specialist
WV Department of Health and Human Resources
Danville, WV
04.1989 - 05.1991
- Conducted comprehensive assessments to determine client eligibility for employment services.
- Developed individualized employment plans to align clients with suitable job opportunities.
- Facilitated workshops to enhance job search skills and interview preparedness for clients.
- Collaborated with community organizations to expand resources and support networks for clients.
Education
Associate of Applied Science - Secretarial
Southern WV Community College
Madison, WV06-1992
Skills
- Critical Decision-making
- ICD-9 coding
- Insurance claims processing
- Customer service
- Claim denial resolution
Timeline
Medical Claims Processor
Accordia National Insurance
07.1993 - 09.1995
Refund Specialist
Accordia National Insurance
06.1991 - 07.1993
Employment Service Specialist
WV Department of Health and Human Resources
04.1989 - 05.1991
Associate of Applied Science - Secretarial
Southern WV Community College